Healthcare Provider Details

I. General information

NPI: 1649235920
Provider Name (Legal Business Name): NANCY L AGUIRRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MCMILLEN ST
FORT ATKINSON WI
53538-1275
US

IV. Provider business mailing address

650 MCMILLEN ST
FORT ATKINSON WI
53538-1275
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-8900
  • Fax: 920-563-0318
Mailing address:
  • Phone: 920-563-8900
  • Fax: 920-563-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number49257
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1319-TEP
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: