Provider Demographics
NPI:1073246138
Name:BARANCZYK, KAY SUSAN (APNP)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:SUSAN
Last Name:BARANCZYK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:SUSAN
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1630 COMMANCHE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-433-6000
Practice Address - Fax:920-430-4719
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13020-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06220244OtherAANP