MEDICARE: DONALD CAMILLO CRNA PC

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
1	367500000X	Certified Registered Nurse Anesthetist	35211	TX

General Provider Information

NPI Number	:	1902112303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD CAMILLO CRNA PC

Provider Business Mailing Address
First Line	:	PO BOX 292394
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75029-2394
Country	:	US
Telephone Number	:	972-668-7460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 LAKEPOINTE DR
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6442
Country	:	US
Telephone Number	:	972-315-1401
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD CAMILLO
Credential	:	CRNA
Telephone Number	:	972-668-7460

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	12/29/2010

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