Provider Demographics
NPI:1013278555
Name:ORNELLA, CAMERON M (CNA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:M
Last Name:ORNELLA
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:MR
Other - First Name:CAMERON
Other - Middle Name:M
Other - Last Name:ORNELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:1915 55TH ST SE
Mailing Address - Street 2:APT A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-3958
Mailing Address - Country:US
Mailing Address - Phone:360-421-9227
Mailing Address - Fax:
Practice Address - Street 1:1915 55TH ST SE
Practice Address - Street 2:APT A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-3958
Practice Address - Country:US
Practice Address - Phone:360-421-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA60202053374U00000X
WANA 60164357376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide