Provider Demographics
NPI:1275790370
Name:STOERZBACH, NANCY A (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:STOERZBACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W309N5511 WINDRISE CIR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1036
Mailing Address - Country:US
Mailing Address - Phone:262-367-9070
Mailing Address - Fax:
Practice Address - Street 1:W309N5511 WINDRISE CIR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1036
Practice Address - Country:US
Practice Address - Phone:262-367-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75484-030163W00000X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39841500Medicaid