Provider Demographics
NPI:1134406085
Name:PANZER, NANCYANZER JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:NANCYANZER
Middle Name:JEAN
Last Name:PANZER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:NY
Mailing Address - Zip Code:14543-9755
Mailing Address - Country:US
Mailing Address - Phone:585-359-5460
Mailing Address - Fax:585-359-5463
Practice Address - Street 1:5509 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:RUSH
Practice Address - State:NY
Practice Address - Zip Code:14543-9755
Practice Address - Country:US
Practice Address - Phone:585-359-5460
Practice Address - Fax:585-359-5463
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288972-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497492Medicaid