Healthcare Provider Details

I. General information

NPI: 1225667918
Provider Name (Legal Business Name): NATHAN WOODBURY CAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 W ELM AVE
HERMISTON OR
97838-6933
US

IV. Provider business mailing address

1122 W ELM AVE
HERMISTON OR
97838-6933
US

V. Phone/Fax

Practice location:
  • Phone: 541-289-7075
  • Fax: 541-314-4873
Mailing address:
  • Phone: 541-289-7075
  • Fax: 541-314-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD224730
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: