Provider Demographics
NPI:1669711925
Name:CAMERON, BRIENNA M (PA-C)
Entity type:Individual
Prefix:
First Name:BRIENNA
Middle Name:M
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIENNA
Other - Middle Name:M
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:6940 VAN DORN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2858
Mailing Address - Country:US
Mailing Address - Phone:402-323-8572
Mailing Address - Fax:
Practice Address - Street 1:303 EAST ST
Practice Address - Street 2:
Practice Address - City:LYNNVILLE
Practice Address - State:IA
Practice Address - Zip Code:50153-7719
Practice Address - Country:US
Practice Address - Phone:641-527-2929
Practice Address - Fax:641-527-2922
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE00000208VP0000X
IA074695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5101771OtherIOWA CONTROLLED
IAMC2838968OtherFEDERAL DEA