Healthcare Provider Details

I. General information

NPI: 1861022022
Provider Name (Legal Business Name): ANGELIQUE NETZBAND-FISCHER CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELIQUE NETZBAND-FISCHER SAC

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W POINT RD
GREEN BAY WI
54304-1344
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-490-3790
  • Fax:
Mailing address:
  • Phone: 920-869-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17075-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: