MEDICARE: ISMAEL D FANNY LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	260333-30	WI

General Provider Information

NPI Number	:	1144397936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAEL D FANNY LPN

Provider Business Mailing Address
First Line	:	18 RIDGEVIEW CT APT 5
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-4383
Country	:	US
Telephone Number	:	608-301-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 BAY VW
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1402
Country	:	US
Telephone Number	:	608-255-1914
Fax Number	:	413-383-1691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/23/2024

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