Provider Demographics
NPI:1639188758
Name:CAMERON, DARLA NADINE (FNP)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:NADINE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:NADINE
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8941
Mailing Address - Fax:207-777-4397
Practice Address - Street 1:21 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1422
Practice Address - Country:US
Practice Address - Phone:207-862-0300
Practice Address - Fax:207-907-1041
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME245320099Medicaid
MEP61817Medicare UPIN
ME245320099Medicaid