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NPI Code Detail

MEDICARE: MS. NANCY ANN FENNEMA MSSW

MEDICARE: MS. NANCY ANN FENNEMA MSSW
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
1101YP2500XProfessional Counselor1886-125WI
21041C0700XClinical Social Worker1999-123WI

General Provider Information

NPI Number : 1568776979
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY ANN FENNEMA MSSW
Provider Business Mailing Address
First Line : 1825 RIVERSIDE DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-2316
Country : US
Telephone Number : 920-272-8234
Fax Number : 920-437-4067
Provider Business Practice Location Address
First Line : 1825 RIVERSIDE DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-2316
Country : US
Telephone Number : 920-272-8234
Fax Number : 920-437-4067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2010
Last Update Date : 07/28/2010

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