Provider Demographics
NPI:1275232142
Name:BUXTON, ANDREA BROOKE (APNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:BROOKE
Last Name:BUXTON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5622
Mailing Address - Country:US
Mailing Address - Phone:920-965-0606
Mailing Address - Fax:920-965-0607
Practice Address - Street 1:2060 BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5622
Practice Address - Country:US
Practice Address - Phone:920-965-0606
Practice Address - Fax:920-965-0607
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13663-33207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13663-33OtherSTATE LICENSE