Provider Demographics
NPI:1629141049
Name:CAMERON, NANETTE MICHELLE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:MICHELLE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28289 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5436
Mailing Address - Country:US
Mailing Address - Phone:810-333-2872
Mailing Address - Fax:
Practice Address - Street 1:11994 HYNE RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9234
Practice Address - Country:US
Practice Address - Phone:810-333-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI833070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N70170Medicare PIN