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General NPI Number Information
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NPI Number | 1679017925
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Entity Type | Individual
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Provider Name | CHRISTINA L. CLANCY C.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 146 E GENEVA SQ
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City | LAKE GENEVA
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State | WI
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Zip | 53147
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Country | US
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Telephone | 262-249-4660
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Fax | 262-249-7128
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Provider Business Mailing Address
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Address Line | 146 E GENEVA SQ
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City | LAKE GENEVA
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State | WI
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Zip | 53147-9694
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Country | US
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Telephone | 262-249-4660
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Fax | 262-249-7128
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.019992
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209017362
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9353
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License Number State | WI
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