Basic Information
| Provider Information | |||||||||
| NPI: | 1093799223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHARAMOND | ||||||||
| FirstName: | CAMILLA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SLAWEK | ||||||||
| OtherFirstName: | CAMILLA | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 123 FRANKLIN CORNER RD STE 214 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086482526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377200 | ||||||||
| FaxNumber: | 6098963986 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 FRANKLIN CORNER RD STE 214 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086482526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | MW008611L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 163W00000X | RN520777L | PA | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 7732340 | 01 | AETNA PPO | OTHER | 2722469 | 01 | AETNA HMO | OTHER | 2017306000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 30002954 | 01 | KEYSTONE MERCY | OTHER | 420001611 | 01 | RR MEDICARE | OTHER | 001887412 | 05 | PA | MEDICAID | 3Y2715 | 01 | HEALTH NET | OTHER | 1324617 | 01 | HIGHMARK BLUE SHIELD | OTHER | 2120472 | 01 | MAMSI | OTHER |