Provider Demographics
NPI:1598232878
Name:SAXON, ANDREA KIMBERLY (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KIMBERLY
Last Name:SAXON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3631
Mailing Address - Country:US
Mailing Address - Phone:920-946-9841
Mailing Address - Fax:
Practice Address - Street 1:3166 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3631
Practice Address - Country:US
Practice Address - Phone:920-946-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI241669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty