1669711925 NPI number — BRIENNA M CAMERON PA-C

Table of content: BRIENNA M CAMERON PA-C (NPI 1669711925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669711925 NPI number — BRIENNA M CAMERON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMERON
Provider First Name:
BRIENNA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMERON
Provider Other First Name:
BRIENNA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669711925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6940 VAN DORN ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-2858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-323-8572
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50153-7719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-527-2929
Provider Business Practice Location Address Fax Number:
641-527-2922
Provider Enumeration Date:
02/06/2013

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: 208VP0000X , with the licence number:  00000 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 074695 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5101771 . This is a "IOWA CONTROLLED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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