Healthcare Provider Details

I. General information

NPI: 1083699581
Provider Name (Legal Business Name): CAMISHA QUINISE BOATWRIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HHC 121 GENERAL HOSPITAL BOX #42
APO AP
96205
KR

IV. Provider business mailing address

HHC 121 GENERAL HOSPITAL BOX #42
APO AP
96205
KR

V. Phone/Fax

Practice location:
  • Phone: 7375575
  • Fax:
Mailing address:
  • Phone: 7375575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0001189731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: