Provider Demographics
NPI:1275613424
Name:CAMACHO, MARTIN (APRN-RX, ACNP-BC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:
Credentials:APRN-RX, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6010
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6010
Mailing Address - Country:US
Mailing Address - Phone:406-455-4320
Mailing Address - Fax:406-731-8318
Practice Address - Street 1:1300 28TH ST S FL 2
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5296
Practice Address - Country:US
Practice Address - Phone:406-455-4320
Practice Address - Fax:406-731-8318
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-73940163WC0200X, 163WE0003X
HIAPRN-1571363L00000X, 363LA2100X, 363LC0200X
PASPOO8067363L00000X
MT225940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine