Provider Demographics
NPI:1548903917
Name:CAMARENA, JOHANNA CLAIRE (CPM)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:CLAIRE
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HENNIE ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1106
Mailing Address - Country:US
Mailing Address - Phone:920-312-9087
Mailing Address - Fax:920-273-2616
Practice Address - Street 1:110 ALGOMA BLVD STE B
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4858
Practice Address - Country:US
Practice Address - Phone:920-230-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI250-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife