Basic Information
| Provider Information | |||||||||
| NPI: | 1982796512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELICK-SHAWVER | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 WEST VOTAW STREET | ||||||||
| Address2: | SUITE A , P.O. BOX 710 | ||||||||
| City: | PORTLAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473710710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607268822 | ||||||||
| FaxNumber: | 2607267857 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 WEST VOTAW STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PORTLAND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473710710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607268822 | ||||||||
| FaxNumber: | 2607267857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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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 | 363LF0000X | 71001055A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.