Provider Demographics
NPI:1619535184
Name:BORTOLAMEOLLI, NANCY ELAINE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELAINE
Last Name:BORTOLAMEOLLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 S ONEIDA ST STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1755
Mailing Address - Country:US
Mailing Address - Phone:920-749-9700
Mailing Address - Fax:920-749-1595
Practice Address - Street 1:2501 S ONEIDA ST STE B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1755
Practice Address - Country:US
Practice Address - Phone:920-749-9700
Practice Address - Fax:920-749-1595
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care