Provider Demographics
NPI:1497394910
Name:PETERSON-DEVRIES, CAMILLA (CNP)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:
Last Name:PETERSON-DEVRIES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61266 193RD ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-6461
Mailing Address - Country:US
Mailing Address - Phone:320-287-0313
Mailing Address - Fax:
Practice Address - Street 1:18 2ND ST N
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1118
Practice Address - Country:US
Practice Address - Phone:320-732-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7145363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health