MEDICARE: NANCY YVETTE LONGHENRY RN

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	163W00000X	Registered Nurse	114823-030	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821425927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY YVETTE LONGHENRY RN

Provider Business Mailing Address
First Line	:	134 W MADISON AVE
Second Line	:	PO BOX 337
City	:	GRANTSBURG
State	:	WI
Zip	:	54840-7022
Country	:	US
Telephone Number	:	715-463-5004
Fax Number	:	715-463-5003

Provider Business Practice Location Address
First Line	:	134 W MADISON AVE
Second Line	:
City	:	GRANTSBURG
State	:	WI
Zip	:	54840-7022
Country	:	US
Telephone Number	:	715-463-5004
Fax Number	:	715-463-5003

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

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	10/03/2013

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