Provider Demographics
NPI:1790856417
Name:CAMERON, NANCY WISE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:WISE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:117 EAST KINGS HIGHWAY
Mailing Address - Street 2:MOREHEAD MEMORIAL HOSPITAL
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288
Mailing Address - Country:US
Mailing Address - Phone:336-623-9711
Mailing Address - Fax:336-623-2434
Practice Address - Street 1:6845 HIGHWAY 135
Practice Address - Street 2:MCMICHAEL HIGH SCHOOL
Practice Address - City:MAYODAN
Practice Address - State:NC
Practice Address - Zip Code:27027
Practice Address - Country:US
Practice Address - Phone:336-427-4335
Practice Address - Fax:336-427-4335
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300219363LP0200X
NC036587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000158Medicaid
NC1248JOtherBLUE CROSS BLUE SHIELD
P04048Medicare UPIN