Provider Demographics
NPI:1679796742
Name:FENSCH, NANCY JOAN
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JOAN
Last Name:FENSCH
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 1:241 FAIRLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7050
Mailing Address - Country:US
Mailing Address - Phone:419-529-6774
Mailing Address - Fax:
Practice Address - Street 1:241 FAIRLAWN AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7050
Practice Address - Country:US
Practice Address - Phone:419-529-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2636740Medicaid