Provider Demographics
NPI:1659376614
Name:DANZ, CHRISTINA D (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:D
Last Name:DANZ
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 1:3913 W PROSPECT AVE
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8798
Mailing Address - Country:US
Mailing Address - Phone:920-729-7105
Mailing Address - Fax:
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Practice Address - Street 2:STE 130
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-729-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRN85763-030363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43954800Medicaid
WI000471525Medicare ID - Type Unspecified
WI43954800Medicaid
WIP56676Medicare UPIN