Provider Demographics
NPI:1649235920
Name:AGUIRRE, NANCY L (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1275
Mailing Address - Country:US
Mailing Address - Phone:920-563-8900
Mailing Address - Fax:920-563-0318
Practice Address - Street 1:650 MCMILLEN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1275
Practice Address - Country:US
Practice Address - Phone:920-563-8900
Practice Address - Fax:920-563-0318
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1319-TEP207V00000X
WI49257390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIFA3428845OtherDEA
WI303450131Medicare PIN