Provider Demographics
NPI:1942536206
Name:SMIEGOWSKI, NANCY MARY (MSN ANP-BC, GNP-BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARY
Last Name:SMIEGOWSKI
Suffix:
Gender:F
Credentials:MSN ANP-BC, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-3104
Mailing Address - Country:US
Mailing Address - Phone:262-895-2151
Mailing Address - Fax:
Practice Address - Street 1:ZABLOCKI VA MEDICAL CTR
Practice Address - Street 2:5000 WEST NATIONAL AVENUE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI349556363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39286500Medicaid
WI084713001Medicare UPIN