1205960028 NPI number — DR. ELIZABETH A CAMP N.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205960028 NPI number — DR. ELIZABETH A CAMP N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMP
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205960028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2321 LINDENWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73071-7410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-391-9820
Provider Business Mailing Address Fax Number:
866-953-1710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 MAIN ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-391-9820
Provider Business Practice Location Address Fax Number:
866-953-1710
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  56 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133N00000X , with the licence number: 15005 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 56 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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