Provider Demographics
NPI:1285732578
Name:CAMERON, ELIZABETH H (CNP)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:H
Last Name:CAMERON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-3936
Mailing Address - Country:US
Mailing Address - Phone:208-785-0270
Mailing Address - Fax:208-785-0683
Practice Address - Street 1:1395 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-3936
Practice Address - Country:US
Practice Address - Phone:208-785-0270
Practice Address - Fax:208-785-0683
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 676-A363LF0000X, 363LW0102X, 363LX0001X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807281300Medicaid