Provider Demographics
NPI:1447458237
Name:CAMRON, CARY RAY (LPN)
Entity type:Individual
Prefix:MR
First Name:CARY
Middle Name:RAY
Last Name:CAMRON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 DARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2517
Mailing Address - Country:US
Mailing Address - Phone:937-832-9977
Mailing Address - Fax:937-832-9977
Practice Address - Street 1:4615 DARTFORD RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2517
Practice Address - Country:US
Practice Address - Phone:937-832-9977
Practice Address - Fax:937-832-9977
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN072341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse