Provider Demographics
NPI:1568496057
Name:FUTCH, NANCY W (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:FUTCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5323
Mailing Address - Country:US
Mailing Address - Phone:912-284-2572
Mailing Address - Fax:912-284-2522
Practice Address - Street 1:604 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5323
Practice Address - Country:US
Practice Address - Phone:912-284-2572
Practice Address - Fax:912-284-2522
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN051276163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBDBBMedicare ID - Type UnspecifiedJEFF DAVIS HD
GAS89391Medicare UPIN
GA50BBCZXMedicare ID - Type UnspecifiedWARE HD