Healthcare Provider Details

I. General information

NPI: 1881320760
Provider Name (Legal Business Name): DANNA ANNE DERENNE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. DANNA ANNE WARD

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 COMMANCHE AVE
GREEN BAY WI
54313-5751
US

IV. Provider business mailing address

PO BOX 23400
GREEN BAY WI
54305-3400
US

V. Phone/Fax

Practice location:
  • Phone: 920-435-8326
  • Fax:
Mailing address:
  • Phone: 920-435-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13041-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13041-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: