Provider Demographics
NPI:1821620469
Name:RADJASSEGARANE, CAMATCHY
Entity Type:Individual
Prefix:MRS
First Name:CAMATCHY
Middle Name:
Last Name:RADJASSEGARANE
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 1:2653 BAD ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-1000
Mailing Address - Country:US
Mailing Address - Phone:702-372-9338
Mailing Address - Fax:
Practice Address - Street 1:2653 BAD ROCK CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-1000
Practice Address - Country:US
Practice Address - Phone:702-445-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV828876363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care