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NPI Code Detail

MEDICARE: CAMILLE BASCOM

MEDICARE: CAMILLE BASCOM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse317355NY

General Provider Information

NPI Number : 1508238759
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLE BASCOM
Provider Business Mailing Address
First Line : 1326 ALBANY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-5638
Country : US
Telephone Number : 347-444-0451
Fax Number :
Provider Business Practice Location Address
First Line : 1326 ALBANY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-5638
Country : US
Telephone Number : 347-444-0451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2015
Last Update Date : 10/28/2015

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Directions to “ CAMILLE BASCOM ” Practice Location

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