Individual
CAMRON REZA ANSARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 341-7246
Mailing address
20 MEDICAL VILLAGE DR, 258, EDGEWOOD, KY 41017-5401
(859) 341-7246
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1104576
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
081074
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000596705
ANTHEM
—
05
—
200929960
—
IN
05
—
2939968
—
OH
05
—
7100061830
—
KY
Enumeration date
10/28/2008
Last updated
07/22/2009
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