Provider Demographics
NPI:1639970213
Name:WASDEN, CAMILLE (NP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:WASDEN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10641 W EUCALYPTUS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5746
Mailing Address - Country:US
Mailing Address - Phone:208-965-9414
Mailing Address - Fax:
Practice Address - Street 1:7727 W DEER VALLEY RD STE 215
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2121
Practice Address - Country:US
Practice Address - Phone:623-404-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily