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NPI Code Detail

MEDICARE: CAMILLE BACCUS

MEDICARE: CAMILLE BACCUS
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
1164W00000XLicensed Practical Nurse155961OH

General Provider Information

NPI Number : 1386035020
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLE BACCUS
Provider Business Mailing Address
First Line : 5228 SHASTA AVE
Second Line :
City : DAYTON
State : OH
Zip : 45417-9113
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5228 SHASTA AVE
Second Line :
City : DAYTON
State : OH
Zip : 45417-9113
Country : US
Telephone Number : 937-732-1185
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2015
Last Update Date : 02/17/2015

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Directions to “ CAMILLE BACCUS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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