Provider Demographics
NPI:1558808188
Name:MCKAMY, CONNIE (LVN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MCKAMY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:BIGGS
Mailing Address - State:CA
Mailing Address - Zip Code:95917
Mailing Address - Country:US
Mailing Address - Phone:530-990-5363
Mailing Address - Fax:
Practice Address - Street 1:2978 9TH STREET
Practice Address - Street 2:
Practice Address - City:BIGGS
Practice Address - State:CA
Practice Address - Zip Code:95917
Practice Address - Country:US
Practice Address - Phone:530-990-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 207083164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse