Provider Demographics
NPI:1457983710
Name:CAMERON, LISA VIRGINIA (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:VIRGINIA
Last Name:CAMERON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14103 LOWE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-5735
Mailing Address - Country:US
Mailing Address - Phone:586-212-6606
Mailing Address - Fax:
Practice Address - Street 1:46591 ROMEO PLANK RD STE 220
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5705
Practice Address - Country:US
Practice Address - Phone:586-226-6170
Practice Address - Fax:586-226-6168
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily