Provider Demographics
NPI:1639540826
Name:MOONSAMMY, CAMILLE M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:M
Last Name:MOONSAMMY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LADD ST STE 319
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4361
Mailing Address - Country:US
Mailing Address - Phone:401-206-0110
Mailing Address - Fax:401-789-2349
Practice Address - Street 1:42 LADD ST STE 319
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4361
Practice Address - Country:US
Practice Address - Phone:401-206-0110
Practice Address - Fax:401-789-2349
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01546163WP0808X, 363LA2200X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health