Healthcare Provider Details

I. General information

NPI: 1679229181
Provider Name (Legal Business Name): NANCY ELLEN PLOTKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 W HUNT CLUB CIR
MILWAUKEE WI
53209-1827
US

IV. Provider business mailing address

2541 W HUNT CLUB CIR
MILWAUKEE WI
53209-1827
US

V. Phone/Fax

Practice location:
  • Phone: 414-305-9829
  • Fax:
Mailing address:
  • Phone: 414-305-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77270-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: