Provider Demographics
NPI:1023125580
Name:MARCHETTA, ANN E (NP)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:MARCHETTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GROVE AVE
Mailing Address - Street 2:PO BOX 314
Mailing Address - City:WILD ROSE
Mailing Address - State:WI
Mailing Address - Zip Code:54984-6901
Mailing Address - Country:US
Mailing Address - Phone:920-622-5560
Mailing Address - Fax:920-622-5598
Practice Address - Street 1:1533 S BROWNLEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3131
Practice Address - Country:US
Practice Address - Phone:361-884-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI943-033363L00000X
TX650349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI363LF0000XMedicaid
WI0060Medicare PIN