1669448742 NPI number — CAMILLE KATHERINE WISSMANN PHARM D

Table of content: CAMILLE KATHERINE WISSMANN PHARM D (NPI 1669448742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669448742 NPI number — CAMILLE KATHERINE WISSMANN PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISSMANN
Provider First Name:
CAMILLE
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WISSMANN
Provider Other First Name:
CAMILLE
Provider Other Middle Name:
JOHNSON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669448742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 W WINDTREE DR
Provider Second Line Business Mailing Address:
923 W WINDTREE DRIVE
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54914-7222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-268-7251
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 LARIMER ST
Provider Second Line Business Practice Location Address:
SUITE 896
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80202-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-336-1530
Provider Business Practice Location Address Fax Number:
888-502-0655
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  051037824 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 29988 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 13629 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 9984 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 10702040 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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