Provider Demographics
NPI:1558008219
Name:CLANCY, FRANK JAMES
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JAMES
Last Name:CLANCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 N CAMBRIDGE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3293
Mailing Address - Country:US
Mailing Address - Phone:414-736-1940
Mailing Address - Fax:
Practice Address - Street 1:2904 N CAMBRIDGE AVE APT 301
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3293
Practice Address - Country:US
Practice Address - Phone:414-736-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI190586-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse