Healthcare Provider Details

I. General information

NPI: 1689879223
Provider Name (Legal Business Name): BERTHA PETERS CAMACHO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MH II BLDG MARINA HEIGHTS BUSINESS PARK SUITE 101
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 504204
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-323-9000
  • Fax: 670-323-9010
Mailing address:
  • Phone: 670-256-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0051
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: