Provider Demographics
NPI:1891341798
Name:BARAJAS, CAMILLA ANNE (RN, BSN, CDE)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:ANNE
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:RN, BSN, CDE
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 487
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071-0487
Mailing Address - Country:US
Mailing Address - Phone:402-878-2722
Mailing Address - Fax:
Practice Address - Street 1:225 SOUTH BLUFF STREET
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-878-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA131262163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator