Healthcare Provider Details

I. General information

NPI: 1588834485
Provider Name (Legal Business Name): CAROLINE TERESA CAMPESE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WARDENBURG DR
BOULDER CO
80309-5904
US

IV. Provider business mailing address

4201 TUDOR CENTRE DR SUITE 320
ANCHORAGE AK
99508-5904
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-3028
  • Fax: 303-492-8222
Mailing address:
  • Phone: 907-729-8624
  • Fax: 907-729-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0991601
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number267400
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1050
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: