Provider Demographics
NPI:1255832713
Name:CAMMON, RODNEY WILLIE (PCA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:WILLIE
Last Name:CAMMON
Suffix:
Gender:M
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 E TROPICANA AVE APT 16C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6705
Mailing Address - Country:US
Mailing Address - Phone:216-773-2315
Mailing Address - Fax:
Practice Address - Street 1:5100 E TROPICANA AVE APT 16C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6705
Practice Address - Country:US
Practice Address - Phone:216-773-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health