Healthcare Provider Details

I. General information

NPI: 1093989808
Provider Name (Legal Business Name): NANCY ANN TOWNZEN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY ANN BLAYLOCK RN, CDE

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAPLE SUMMIT RD JERSEY COMMUNITY HOSPITAL
JERSEYVILLE IL
62052-2028
US

IV. Provider business mailing address

310 W CENTER ST
BRIGHTON IL
62012-1134
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-8402
  • Fax:
Mailing address:
  • Phone: 775-229-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN18588
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041.177498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: