Healthcare Provider Details

I. General information

NPI: 1841112471
Provider Name (Legal Business Name): ANNA SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MENGES

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKEFRONT WAY
TWO RIVERS WI
54241-3301
US

IV. Provider business mailing address

1478 GUNS RD
GREEN BAY WI
54311-6008
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07260257
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: