Healthcare Provider Details

I. General information

NPI: 1972177582
Provider Name (Legal Business Name): NICOLE CAMARDO DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 S PULASKI RD
CHICAGO IL
60629-4400
US

IV. Provider business mailing address

1420 W POLK ST
CHICAGO IL
60607-4991
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 847-457-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209023482
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: