Healthcare Provider Details

I. General information

NPI: 1609067388
Provider Name (Legal Business Name): NANCY L BUCHHOLZ APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY L BUCHHOLZ APNP

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E CAPITOL DR
APPLETON WI
54911-8735
US

IV. Provider business mailing address

2500 E CAPITOL DR
APPLETON WI
54911-8735
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-4600
  • Fax:
Mailing address:
  • Phone: 920-738-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number79309
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4030-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: