Healthcare Provider Details

I. General information

NPI: 1275596371
Provider Name (Legal Business Name): CAMILLE L WOODS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE STE 800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 800
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax: 602-462-1186
Mailing address:
  • Phone: 602-462-1132
  • Fax: 602-462-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN062815
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0614
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: