Provider Demographics
NPI:1396304531
Name:CAMILO, MEAGHAN ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:ELIZABETH
Last Name:CAMILO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:200 RED CREEK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5261
Mailing Address - Country:US
Mailing Address - Phone:585-334-0130
Mailing Address - Fax:585-334-0213
Practice Address - Street 1:200 RED CREEK DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5261
Practice Address - Country:US
Practice Address - Phone:585-334-0130
Practice Address - Fax:585-334-0213
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674243163W00000X
NY344418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse