Provider Demographics
NPI:1659039519
Name:EMMANS, CAMILLA (RN)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:EMMANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2602
Mailing Address - Country:US
Mailing Address - Phone:763-421-2725
Mailing Address - Fax:
Practice Address - Street 1:927 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2602
Practice Address - Country:US
Practice Address - Phone:763-421-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR136279-2163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management