Provider Demographics
NPI:1447027842
Name:LE, INDIA CAMILLE (APNP)
Entity type:Individual
Prefix:
First Name:INDIA
Middle Name:CAMILLE
Last Name:LE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:INDIA
Other - Middle Name:CAMILLE
Other - Last Name:HOFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4800 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2412
Mailing Address - Country:US
Mailing Address - Phone:414-744-5370
Mailing Address - Fax:
Practice Address - Street 1:949 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1422
Practice Address - Country:US
Practice Address - Phone:414-226-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242210163W00000X, 163WA0400X
WI15544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)