Basic Information
| Provider Information | |||||||||
| NPI: | 1528723533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMING | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | LA RAE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1121 | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974700254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416722691 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 VIRGINIA AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORTH BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974593444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417510357 | ||||||||
| FaxNumber: | 5417519985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 202010599RN | OR | N | Nursing Service Providers | Registered Nurse | 171M00000X | OR | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.