Provider Demographics
NPI:1205227758
Name:INGLE, CAMILLE ROSE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ROSE
Last Name:INGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W CENTRAL ENTRANCE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5448
Mailing Address - Country:US
Mailing Address - Phone:218-249-4987
Mailing Address - Fax:218-249-4989
Practice Address - Street 1:619 W CENTRAL ENTRANCE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5448
Practice Address - Country:US
Practice Address - Phone:218-249-4987
Practice Address - Fax:218-249-4989
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant