Provider Demographics
NPI:1598412165
Name:LAST, CAMILLE ELISABETH (FNP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ELISABETH
Last Name:LAST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 N DAISY DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3211
Mailing Address - Country:US
Mailing Address - Phone:801-808-3881
Mailing Address - Fax:
Practice Address - Street 1:2661 N DAISY DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3211
Practice Address - Country:US
Practice Address - Phone:801-808-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF03220085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily