Provider Demographics
NPI:1255162244
Name:SMITH, CAMILLA DEANN (RN)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:DEANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7953 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011-2088
Mailing Address - Country:US
Mailing Address - Phone:316-300-3884
Mailing Address - Fax:
Practice Address - Street 1:400 FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011-2088
Practice Address - Country:US
Practice Address - Phone:509-565-3607
Practice Address - Fax:509-565-3601
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61236318163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool