Provider Demographics
NPI:1255038030
Name:GAZZALE, CAMILLE LYNN
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:LYNN
Last Name:GAZZALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11531 STATE ROUTE 821
Mailing Address - Street 2:
Mailing Address - City:LOWER SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:45745-8838
Mailing Address - Country:US
Mailing Address - Phone:740-525-2991
Mailing Address - Fax:
Practice Address - Street 1:4790 LOWELL HILL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:OH
Practice Address - Zip Code:45744-7138
Practice Address - Country:US
Practice Address - Phone:740-525-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker