Provider Demographics
NPI:1669920724
Name:KARWISCH, CAMILLE
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:KARWISCH
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 1:120 E MALLARD DR
Mailing Address - Street 2:#218
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3984
Mailing Address - Country:US
Mailing Address - Phone:706-248-6432
Mailing Address - Fax:
Practice Address - Street 1:8211 W USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5756
Practice Address - Country:US
Practice Address - Phone:208-375-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program