Basic Information
| Provider Information | |||||||||
| NPI: | 1073700357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPAGNA | ||||||||
| FirstName: | NICOLETTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2533 LOCHMABEN ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890441572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629142477 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1505 WIGWAM PKWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890748194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028561400 | ||||||||
| FaxNumber: | 7028561401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 05/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 309003520 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | APRN002162 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.