Provider Demographics
NPI:1629383369
Name:CAMACHO, JOHN ABEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ABEL
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14936 HADCOCK DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:NY
Mailing Address - Zip Code:13156-4185
Mailing Address - Country:US
Mailing Address - Phone:585-694-6622
Mailing Address - Fax:
Practice Address - Street 1:14936 HADCOCK DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NY
Practice Address - Zip Code:13156-4185
Practice Address - Country:US
Practice Address - Phone:585-694-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300346164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse