Provider Demographics
NPI:1689739328
Name:MACY, NANCY ANN (WHCNP CNM)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:MACY
Suffix:
Gender:F
Credentials:WHCNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BRUTSCHER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6096
Mailing Address - Country:US
Mailing Address - Phone:503-454-0018
Mailing Address - Fax:503-848-3471
Practice Address - Street 1:19365 SW 65TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-454-0018
Practice Address - Fax:503-848-3471
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150033NP367A00000X
OR091000472N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276365Medicaid
OR276365Medicaid