Healthcare Provider Details

I. General information

NPI: 1336161207
Provider Name (Legal Business Name): NANETTE MARIE FENZAU RCS-NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 GREEN MEADOW DR
VERONA WI
53593-1512
US

IV. Provider business mailing address

606 GREEN MEADOW DR
VERONA WI
53593-1512
US

V. Phone/Fax

Practice location:
  • Phone: 608-848-4800
  • Fax:
Mailing address:
  • Phone: 608-848-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number17832-031
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number17832-031
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11698-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: