Provider Demographics
NPI:1396712154
Name:FITCH, CAMMI L (CRNA)
Entity type:Individual
Prefix:
First Name:CAMMI
Middle Name:L
Last Name:FITCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 S 70TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-434-5600
Mailing Address - Fax:402-434-5601
Practice Address - Street 1:575 S 70TH ST STE 305
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-434-5600
Practice Address - Fax:402-434-5601
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE100847367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026466300Medicaid
NE277458Medicare ID - Type Unspecified
NE47061979815Medicaid