1972584324 NPI number — MRS. NANCY A MCLAUGHLIN APNP

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	MCLAUGHLIN
Provider First Name	:	NANCY
Provider Middle Name	:	A
Provider Name Prefix Text	:	MRS.
Provider Name Suffix Text	:
Provider Credential Text	:	APNP
Provider Gender Code	:	F

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:	WLODAREZYK
Provider Other First Name	:	NANCY
Provider Other Middle Name	:	A
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:	1

NPI Number	:	1972584324
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	11/13/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	1621 N TAYLOR DR
Provider Second Line Business Mailing Address	:	SUITE 100
Provider Business Mailing Address City Name	:	SHEBOYGAN
Provider Business Mailing Address State Name	:	WI
Provider Business Mailing Address Postal Code	:	530811990
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	9204587433
Provider Business Mailing Address Fax Number	:	9204523594

Provider First Line Business Practice Location Address	:	1621 N TAYLOR DR
Provider Second Line Business Practice Location Address	:	SUITE 100
Provider Business Practice Location Address City Name	:	SHEBOYGAN
Provider Business Practice Location Address State Name	:	WI
Provider Business Practice Location Address Postal Code	:	530811990
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	9204587433
Provider Business Practice Location Address Fax Number	:	9204523594
Provider Enumeration Date	:	11/10/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 363LA2200X , with the licence number:  2352033 , registered in the state of WI .

• Identifier: 602600005 , issued by the state of ( WI ) . This identifiers is of the category "".
• Identifier: 41189900 , issued by the state of ( WI ) . This identifiers is of the category "".
• Identifier: R88824 . This identifiers is of the category "".