Basic Information
| Provider Information | |||||||||
| NPI: | 1902112303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONALD CAMILLO CRNA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 292394 | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750292394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726687460 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1854 LAKEPOINTE DR | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750576442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723151401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 12/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | CAMILLO | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9726687460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 35211 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.