Healthcare Provider Details

I. General information

NPI: 1407694334
Provider Name (Legal Business Name): CAMILLE MARSH MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 CAMDEN RD APT 461
CHARLOTTE NC
28203-6567
US

IV. Provider business mailing address

1207 CREWS RD
MATTHEWS NC
28105-7599
US

V. Phone/Fax

Practice location:
  • Phone: 313-320-2710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number351494
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024727
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: