Provider Demographics
NPI:1689879223
Name:CAMACHO, BERTHA PETERS (NP)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:PETERS
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504204
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-256-3999
Mailing Address - Fax:
Practice Address - Street 1:MH II BLDG MARINA HEIGHTS BUSINESS PARK
Practice Address - Street 2:SUITE 101
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-323-9000
Practice Address - Fax:670-323-9010
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0051363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health