Provider Demographics
NPI:1558728030
Name:WOLD, CAMERON ELIZABETH (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:ELIZABETH
Last Name:WOLD
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:ELIZABETH
Other - Last Name:BROIHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3069
Mailing Address - Country:US
Mailing Address - Phone:888-256-3814
Mailing Address - Fax:888-256-9054
Practice Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3069
Practice Address - Country:US
Practice Address - Phone:888-256-3814
Practice Address - Fax:888-256-9054
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2015021575363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care