Provider Demographics
NPI:1932271756
Name:WERES, NANCY HENNING (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:HENNING
Last Name:WERES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:HENNING
Other - Last Name:WERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3539 BRADSHAW RD
Mailing Address - Street 2:#321
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3539 BRADSHAW RD
Practice Address - Street 2:#321
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3381
Practice Address - Country:US
Practice Address - Phone:916-369-8262
Practice Address - Fax:916-369-8262
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43119208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G431190Medicaid
A49235Medicare UPIN
00G431190Medicare ID - Type Unspecified