Provider Demographics
NPI:1205471489
Name:CAMPANA, KATHERINE TEKAKWITHA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TEKAKWITHA
Last Name:CAMPANA
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 1:4 RIDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-5168
Mailing Address - Country:US
Mailing Address - Phone:845-389-1572
Mailing Address - Fax:
Practice Address - Street 1:30 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3906
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-231-5654
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633539163W00000X
NY001981367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse