Provider Demographics
NPI:1699319004
Name:GREIDER, CAMILLE DEANNA (MSN,RN,FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:DEANNA
Last Name:GREIDER
Suffix:
Gender:F
Credentials:MSN,RN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6944 HOWARD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:IL
Mailing Address - Zip Code:62808-2406
Mailing Address - Country:US
Mailing Address - Phone:573-999-5853
Mailing Address - Fax:
Practice Address - Street 1:1003 E MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3345
Practice Address - Country:US
Practice Address - Phone:618-436-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019056786363LF0000X
IL209024272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily