Provider Demographics
NPI:1699272914
Name:CARRYL, CAMILLE ROSEMARY
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ROSEMARY
Last Name:CARRYL
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 1:132 LANSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8846
Mailing Address - Country:US
Mailing Address - Phone:513-295-2086
Mailing Address - Fax:
Practice Address - Street 1:132 LANSDALE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8846
Practice Address - Country:US
Practice Address - Phone:513-295-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX941508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse