Provider Demographics
NPI:1740238245
Name:CAMPAGNA, ANDREA ROSE (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ROSE
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5611 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5411
Mailing Address - Country:US
Mailing Address - Phone:716-631-8500
Mailing Address - Fax:716-631-5101
Practice Address - Street 1:5611 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5411
Practice Address - Country:US
Practice Address - Phone:716-631-8500
Practice Address - Fax:716-631-5101
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334347363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ25150Medicare UPIN