Basic Information
| Provider Information | |||||||||
| NPI: | 1114457991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMILLERI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 HOGBACK RD STE 5A | ||||||||
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| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347862317 | ||||||||
| FaxNumber: | 7347864977 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 NORTH EAST AVENUE | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177884963 | ||||||||
| FaxNumber: | 5177895903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 4704272138 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.