Provider Demographics
NPI:1467119388
Name:FIELDS, NICOLE (APNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-2276
Mailing Address - Country:US
Mailing Address - Phone:920-324-9899
Mailing Address - Fax:
Practice Address - Street 1:160 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-2276
Practice Address - Country:US
Practice Address - Phone:920-324-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11655-33363LF0000X
WI23265630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse