Provider Demographics
NPI:1689998262
Name:FENNY, NANA SARKOAH IVY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANA SARKOAH
Middle Name:IVY
Last Name:FENNY
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:519 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4017
Practice Address - Country:US
Practice Address - Phone:920-435-6601
Practice Address - Fax:920-436-3840
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.129852207RA0201X
WI82547-20207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI82547-20OtherSATE OF WISCONSIN
CT051053OtherLICENSE