Provider Demographics
NPI:1588993315
Name:CARCAMO, DENISE D (WHNP-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:D
Last Name:CARCAMO
Suffix:
Gender:F
Credentials:WHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 SHERIDAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9208
Mailing Address - Country:US
Mailing Address - Phone:605-348-4141
Mailing Address - Fax:605-342-7880
Practice Address - Street 1:5410 SHERIDAN LAKE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9208
Practice Address - Country:US
Practice Address - Phone:605-348-4141
Practice Address - Fax:605-342-7880
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213714363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704213714OtherLICENSE