Provider Demographics
NPI:1588413256
Name:BOURN-ANDERSON, CAMRY C
Entity type:Individual
Prefix:
First Name:CAMRY
Middle Name:C
Last Name:BOURN-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4123
Mailing Address - Country:US
Mailing Address - Phone:419-315-0906
Mailing Address - Fax:
Practice Address - Street 1:2430 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4123
Practice Address - Country:US
Practice Address - Phone:419-315-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide