Provider Demographics
NPI:1750345393
Name:WEIS, CAMILLE A (APRN)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:WEIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:ARMANINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71 EAST AVE
Mailing Address - Street 2:STE H
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4903
Mailing Address - Country:US
Mailing Address - Phone:203-656-1452
Mailing Address - Fax:203-656-1485
Practice Address - Street 1:71 EAST AVE
Practice Address - Street 2:SUITE V
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4903
Practice Address - Country:US
Practice Address - Phone:203-656-1452
Practice Address - Fax:203-656-1485
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000316363L00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004242400Medicaid
CT500001641Medicare PIN
CTD400015588Medicare PIN
CT004242400Medicaid