MEDICARE: NANCY M PLATTA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	2157	WI

General Provider Information

NPI Number	:	1215127006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY M PLATTA PA

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 S CENTURY AVE
Second Line	:
City	:	WAUNAKEE
State	:	WI
Zip	:	53597-1250
Country	:	US
Telephone Number	:	608-849-7891
Fax Number	:	608-849-7126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	04/29/2009

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