Provider Demographics
NPI:1205943404
Name:WHITEHEAD, NANCY LYNN (FNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:743 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3944
Mailing Address - Country:US
Mailing Address - Phone:262-334-7921
Mailing Address - Fax:262-334-7921
Practice Address - Street 1:807 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9767
Practice Address - Country:US
Practice Address - Phone:262-675-6533
Practice Address - Fax:262-675-2827
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1914-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily