Provider Demographics
NPI:1124645791
Name:NASH, CAMILE E
Entity type:Individual
Prefix:
First Name:CAMILE
Middle Name:E
Last Name:NASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMILE
Other - Middle Name:E
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW/CNA
Mailing Address - Street 1:3333 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2615
Mailing Address - Country:US
Mailing Address - Phone:952-945-4015
Mailing Address - Fax:186-650-1148
Practice Address - Street 1:3333 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2615
Practice Address - Country:US
Practice Address - Phone:952-945-4015
Practice Address - Fax:186-650-1148
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker