Provider Demographics
NPI:1992721112
Name:ROGELL, CAMILLE A (APRN, CNS)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:ROGELL
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5969
Mailing Address - Country:US
Mailing Address - Phone:312-695-4965
Mailing Address - Fax:312-695-5774
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5969
Practice Address - Country:US
Practice Address - Phone:312-695-4965
Practice Address - Fax:312-695-5774
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.003033364SA2200X
IL209-003033364S00000X
IL209003033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ43642Medicare UPIN
ILQ43642Medicare UPIN