Provider Demographics
NPI:1215139860
Name:MACZKA, NANCY RUTH (ADULT PMHNP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:RUTH
Last Name:MACZKA
Suffix:
Gender:F
Credentials:ADULT PMHNP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:RUTH
Other - Last Name:REGIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1244 WISCONSIN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1987
Mailing Address - Country:US
Mailing Address - Phone:262-687-2219
Mailing Address - Fax:
Practice Address - Street 1:1244 WISCONSIN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1987
Practice Address - Country:US
Practice Address - Phone:262-687-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081-033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36038300Medicaid