Provider Demographics
NPI:1639286933
Name:PIGNOTTI, CAMILLIA C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAMILLIA
Middle Name:C
Last Name:PIGNOTTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAMILLIA
Other - Middle Name:C
Other - Last Name:JOUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 S MOORLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2900
Mailing Address - Country:US
Mailing Address - Phone:262-860-7800
Mailing Address - Fax:
Practice Address - Street 1:2801 S MOORLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-2900
Practice Address - Country:US
Practice Address - Phone:262-860-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1249-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42997000Medicaid
MP0843830OtherDEA NUMBER
MP0843830OtherDEA NUMBER
WI42997000Medicaid