Provider Demographics
NPI:1255393443
Name:HERRELL, NANCY CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CAROL
Last Name:HERRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3070 N 51ST ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:414-447-7330
Mailing Address - Fax:414-447-1070
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-7330
Practice Address - Fax:414-447-1070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI234462080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB53577Medicare UPIN