Healthcare Provider Details

I. General information

NPI: 1902800360
Provider Name (Legal Business Name): JULIE A CAMERON C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W 2ND ST S
BROOKINGS SD
57006-1827
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-8684
  • Fax: 605-692-6030
Mailing address:
  • Phone: 605-328-9556
  • Fax: 605-328-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP0251
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000251
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: