MEDICARE: MS. WANDA CAMACHO RN

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	163W00000X	Registered Nurse	604258	NY

General Provider Information

NPI Number	:	1366710105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANDA CAMACHO RN

Provider Business Mailing Address
First Line	:	1400 PELHAM PARKWAY SOUTH.
Second Line	:	JACOBI MEDICAL CENTER WOMEN'S HEALTH SERVICES
City	:	BRONX
State	:	NY
Zip	:	10461-0000
Country	:	US
Telephone Number	:	718-918-4266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 PELHAM PARKWAY SOUTH.
Second Line	:	JACOBI MEDICAL CENTER WOMEN'S HEALTH SERVICES
City	:	BRONX
State	:	NY
Zip	:	10461-0000
Country	:	US
Telephone Number	:	718-918-4266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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