MEDICARE: C L CAMBELL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	852049924405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346556909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C L CAMBELL LLC

Provider Business Mailing Address
First Line	:	728 W 100 S STE 1
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-3764
Country	:	US
Telephone Number	:	435-654-4192
Fax Number	:	435-654-4067

Provider Business Practice Location Address
First Line	:	728 W 100 S STE 1
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-3764
Country	:	US
Telephone Number	:	435-654-4192
Fax Number	:	435-654-4067

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LARA LAPERLE
Credential	:
Telephone Number	:	435-654-4192

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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