Healthcare Provider Details

I. General information

NPI: 1053230391
Provider Name (Legal Business Name): CAMILLE VANNESTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 REGIS BLVD
DENVER CO
80221-1154
US

IV. Provider business mailing address

109 E DAKOTA AVE
DENVER CO
80209-1606
US

V. Phone/Fax

Practice location:
  • Phone: 800-388-2366
  • Fax:
Mailing address:
  • Phone: 540-239-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN.1680802
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: