Basic Information
| Provider Information | |||||||||
| NPI: | 1093455560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMARA | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | ROSEANNA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN NOW NP SHORTLY | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARKHAUER | ||||||||
| OtherFirstName: | MICHELE | ||||||||
| OtherMiddleName: | ROSEANNA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 33 UTAH AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027263616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787930851 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 543 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027402782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089845566 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2022 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN69439 | RI | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN2349061 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.