Provider Demographics
NPI:1891757027
Name:GARCIA, NANCY ANNE (APNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANNE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:ANNE
Other - Last Name:BORENZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 W LINCOLN ST
Mailing Address - Street 2:P.O. 661
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-1949
Mailing Address - Country:US
Mailing Address - Phone:920-324-6235
Mailing Address - Fax:920-324-6288
Practice Address - Street 1:1 W LINCOLN ST
Practice Address - Street 2:P.O. 661
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1949
Practice Address - Country:US
Practice Address - Phone:920-324-6235
Practice Address - Fax:920-324-6288
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2281363LF0000X
WI2281-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41265100Medicaid