Provider Demographics
NPI:1528010477
Name:CAMPBELL, ANDREW MICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7995 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-9786
Mailing Address - Country:US
Mailing Address - Phone:608-635-2274
Mailing Address - Fax:
Practice Address - Street 1:410 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ARENA
Practice Address - State:WI
Practice Address - Zip Code:53503-9685
Practice Address - Country:US
Practice Address - Phone:608-712-0773
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94255-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39967300Medicaid