Provider Demographics
NPI:1013285634
Name:CAMERON, CAMILLE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GOLDEN
Other - Middle Name:TOUCH LICENSED
Other - Last Name:PRACTICAL NURSING SERVICES P.C.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2117 BUFFALO RD # 132
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1507
Mailing Address - Country:US
Mailing Address - Phone:917-407-9875
Mailing Address - Fax:
Practice Address - Street 1:2117 BUFFALO RD # 132
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1507
Practice Address - Country:US
Practice Address - Phone:917-407-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262548164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse