Provider Demographics
NPI:1104028752
Name:FANNIE, NANCY L (RNC, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:FANNIE
Suffix:
Gender:F
Credentials:RNC, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 BROOKTREE CT
Mailing Address - Street 2:STE 230
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9271
Mailing Address - Country:US
Mailing Address - Phone:724-933-7117
Mailing Address - Fax:724-933-7119
Practice Address - Street 1:6400 BROOKTREE CT
Practice Address - Street 2:STE 230
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9271
Practice Address - Country:US
Practice Address - Phone:724-933-7117
Practice Address - Fax:724-933-7119
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001180G363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology