Provider Demographics
NPI:1245719293
Name:CAMARILLO, PRISCILLA (LVN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CAMARILLO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LAKESIDE DR APT 9204
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5193
Mailing Address - Country:US
Mailing Address - Phone:214-254-1613
Mailing Address - Fax:
Practice Address - Street 1:155 LAKESIDE DR APT 9204
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5193
Practice Address - Country:US
Practice Address - Phone:214-254-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339244164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse