Provider Demographics
NPI:1821456351
Name:ROYE-FISHER, CAMILLE NICOLETTE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:NICOLETTE
Last Name:ROYE-FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 JEROME AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2463
Mailing Address - Country:US
Mailing Address - Phone:860-993-6788
Mailing Address - Fax:860-242-1008
Practice Address - Street 1:34 JEROME AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:860-993-6788
Practice Address - Fax:860-242-1008
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0000977251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health