Provider Demographics
NPI:1598143737
Name:CAMEJO, DYHAIVIS (LPN)
Entity Type:Individual
Prefix:MS
First Name:DYHAIVIS
Middle Name:
Last Name:CAMEJO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7699
Mailing Address - Country:US
Mailing Address - Phone:239-208-9676
Mailing Address - Fax:239-208-9679
Practice Address - Street 1:3660 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7699
Practice Address - Country:US
Practice Address - Phone:239-208-9676
Practice Address - Fax:239-208-9679
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5187319164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse