Healthcare Provider Details

I. General information

NPI: 1033933270
Provider Name (Legal Business Name): CHRISTINA IESHA CAMERON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4597 LONESOME PINE DR
MONTGOMERY AL
36108-4821
US

IV. Provider business mailing address

4597 LONESOME PINE DR
MONTGOMERY AL
36108-4821
US

V. Phone/Fax

Practice location:
  • Phone: 334-530-2488
  • Fax:
Mailing address:
  • Phone: 334-530-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-153122
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number1-153122
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number1-153122
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1-153122
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number1-153122
License Number StateAL
# 6
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1-153122
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: