Provider Demographics
NPI:1164415634
Name:JANZ, MARCIE ANN (APNP)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:ANN
Last Name:JANZ
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 E DIVISION ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3748
Mailing Address - Country:US
Mailing Address - Phone:920-929-8120
Mailing Address - Fax:920-929-8126
Practice Address - Street 1:481 E DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3748
Practice Address - Country:US
Practice Address - Phone:920-929-8120
Practice Address - Fax:920-929-8126
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43817600Medicaid
WI43817600Medicaid
WI82896Medicare ID - Type Unspecified