Healthcare Provider Details

I. General information

NPI: 1619426178
Provider Name (Legal Business Name): LAUREN PATRICIA CAMENGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BACK RIVER NECK RD
BALTIMORE MD
21221-3949
US

IV. Provider business mailing address

2 BAILIFFS CT UNIT 301
TIMONIUM MD
21093-1966
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-0246
  • Fax:
Mailing address:
  • Phone: 443-824-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR214852
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: