=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518236298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMELA J MCSWEEN RN, FNP, ACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2011
-----------------------------------------------------
Last Update Date | 03/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 W DAVIS ST
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-2704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-828-3477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14676 DIAMONDHEAD S
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77356-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-588-6711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 572071
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 572071
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------