Basic Information
| Provider Information | |||||||||
| NPI: | 1427032945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMFERDAM | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4828 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504778109 | ||||||||
| FaxNumber: | 8504782412 | ||||||||
| Practice Location | |||||||||
| Address1: | 4810 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504748988 | ||||||||
| FaxNumber: | 8504765312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-037104 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | ARNP867432 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 009984625 | 05 | AL | MEDICAID | 305050500 | 05 | FL | MEDICAID | G0141 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 59115889 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |