Provider Demographics
NPI:1588834485
Name:CAMPESE, CAROLINE TERESA (APRN)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:TERESA
Last Name:CAMPESE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-8624
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:1900 WARDENBURG DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-5904
Practice Address - Country:US
Practice Address - Phone:303-492-3028
Practice Address - Fax:303-492-8222
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991601363LA2200X
MA267400363LA2200X
AK1050363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0018Medicaid
AKK163694Medicare PIN