Healthcare Provider Details

I. General information

NPI: 1699480889
Provider Name (Legal Business Name): CAMILLE ADAIR NORWICK APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LENA ST STE C2
SANTA FE NM
87505-4338
US

IV. Provider business mailing address

369 MONTEZUMA AVE # 128
SANTA FE NM
87501-2835
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-3838
  • Fax:
Mailing address:
  • Phone: 505-470-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71586
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: