Provider Demographics
NPI:1053776229
Name:O'CONNELL, CAMERON (ND)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:1550 TERRACE WAY
Mailing Address - Street 2:#12
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3058
Mailing Address - Country:US
Mailing Address - Phone:971-282-6582
Mailing Address - Fax:
Practice Address - Street 1:1551 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3568
Practice Address - Country:US
Practice Address - Phone:707-586-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#ND775175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath