Provider Demographics
NPI:1609234079
Name:COMPASS, CAMELLE
Entity Type:Individual
Prefix:
First Name:CAMELLE
Middle Name:
Last Name:COMPASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 DE REIMER AVE
Mailing Address - Street 2:1M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1518
Mailing Address - Country:US
Mailing Address - Phone:646-541-9341
Mailing Address - Fax:
Practice Address - Street 1:3410 DE REIMER AVE
Practice Address - Street 2:1M
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1518
Practice Address - Country:US
Practice Address - Phone:646-541-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320242-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse