Provider Demographics
NPI:1326082991
Name:CAMILLO, PATRICIA ANNE (PHD,RNC,APRN-BC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:CAMILLO
Suffix:
Gender:F
Credentials:PHD,RNC,APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390351
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55439-0351
Mailing Address - Country:US
Mailing Address - Phone:917-756-5386
Mailing Address - Fax:
Practice Address - Street 1:2900 THOMAS AVE S APT 1903
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4583
Practice Address - Country:US
Practice Address - Phone:917-756-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114696-3363LW0102X, 363LG0600X
NYF420664-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health