MEDICARE: ANDREA BROOKE BUXTON APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	13663-33	WI
2	363LF0000X	Family Nurse Practitioner	13663-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13663-33	OTHER	WI	STATE LICENSE

General Provider Information

NPI Number	:	1275232142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BROOKE BUXTON APNP

Provider Business Mailing Address
First Line	:	2060 BELLEVUE ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5622
Country	:	US
Telephone Number	:	920-965-0606
Fax Number	:	920-965-0607

Provider Business Practice Location Address
First Line	:	2060 BELLEVUE ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5622
Country	:	US
Telephone Number	:	920-965-0606
Fax Number	:	920-965-0607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	08/09/2024

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