Provider Demographics
NPI:1134096407
Name:CAMPBELL, ANGELA M
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 W GREEN TREE RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2703
Mailing Address - Country:US
Mailing Address - Phone:414-305-5459
Mailing Address - Fax:414-455-3577
Practice Address - Street 1:3614 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2537
Practice Address - Country:US
Practice Address - Phone:414-305-5459
Practice Address - Fax:414-455-3577
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility