Healthcare Provider Details

I. General information

NPI: 1619176104
Provider Name (Legal Business Name): LORAINE CAMACHO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 MANHATTAN AVE
NEW YORK NY
10027-5250
US

IV. Provider business mailing address

24588 62ND AVE
DOUGLASTON NY
11362-2052
US

V. Phone/Fax

Practice location:
  • Phone: 212-222-5221
  • Fax:
Mailing address:
  • Phone: 718-881-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number537125
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: