Provider Demographics
NPI:1124461405
Name:KAMPHUIS, ANDREA (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KAMPHUIS
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 1:229 W WASHINGTON ST
Mailing Address - Street 2:APT 202
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1852
Mailing Address - Country:US
Mailing Address - Phone:920-296-1250
Mailing Address - Fax:
Practice Address - Street 1:127 BETH CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-2649
Practice Address - Country:US
Practice Address - Phone:920-838-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178243-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse