Provider Demographics
NPI:1336161207
Name:FENZAU, NANETTE MARIE (RCS-NURSE)
Entity type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:MARIE
Last Name:FENZAU
Suffix:
Gender:F
Credentials:RCS-NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1512
Mailing Address - Country:US
Mailing Address - Phone:608-848-4800
Mailing Address - Fax:
Practice Address - Street 1:606 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1512
Practice Address - Country:US
Practice Address - Phone:608-848-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17832-031164W00000X, 2278H0200X
WI11698-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI226300000XOtherMASSAGE TRAINING/CERTIFICATION AND NURSING
WI39981500Medicaid