Healthcare Provider Details

I. General information

NPI: 1326082991
Provider Name (Legal Business Name): PATRICIA ANNE CAMILLO PHD,RNC,APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 THOMAS AVE S APT 1903
MINNEAPOLIS MN
55416-4583
US

IV. Provider business mailing address

PO BOX 390351
MINNEAPOLIS MN
55439-0351
US

V. Phone/Fax

Practice location:
  • Phone: 917-756-5386
  • Fax:
Mailing address:
  • Phone: 917-756-5386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number114696-3
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number114696-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: