Basic Information
| Provider Information | |||||||||
| NPI: | 1851967939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMU | ||||||||
| FirstName: | MAYE THERESE | ||||||||
| MiddleName: | NILO | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 491 E ALESSANDRO BLVD | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925086071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517801835 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 491 E ALESSANDRO BLVD | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925086071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517801835 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2021 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95047748 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95016561 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.