Healthcare Provider Details

I. General information

NPI: 1386613032
Provider Name (Legal Business Name): NANCY MARY BLACHOWSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS NANCY MARY KLOPF

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W172N11345 DIVISION RD APT. 4
GERMANTOWN WI
53022-2453
US

IV. Provider business mailing address

2001 N 119TH ST
WAUWATOSA WI
53226-2011
US

V. Phone/Fax

Practice location:
  • Phone: 262-250-1744
  • Fax:
Mailing address:
  • Phone: 414-453-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number112311
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: