Healthcare Provider Details

I. General information

NPI: 1184399354
Provider Name (Legal Business Name): CAMILLE J DONQUE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/04/2023
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 S DOBSON RD
CHANDLER AZ
85224-5665
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 808-212-8384
  • Fax:
Mailing address:
  • Phone: 480-245-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number258264
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: