Provider Demographics
NPI:1518384296
Name:VANACKER, EMILY (LPN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VANACKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 PALMER DR APT 5
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2314
Mailing Address - Country:US
Mailing Address - Phone:608-921-7343
Mailing Address - Fax:
Practice Address - Street 1:3107 PALMER DR APT 5
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2314
Practice Address - Country:US
Practice Address - Phone:608-921-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313009-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse