Provider Demographics
NPI:1841486388
Name:MAZE, CAMISHA LOUISE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CAMISHA
Middle Name:LOUISE
Last Name:MAZE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2912
Mailing Address - Country:US
Mailing Address - Phone:937-367-1547
Mailing Address - Fax:
Practice Address - Street 1:2124 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2912
Practice Address - Country:US
Practice Address - Phone:937-367-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse