Provider Demographics
NPI:1386613032
Name:BLACHOWSKI, NANCY MARY (RN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARY
Last Name:BLACHOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:MARY
Other - Last Name:KLOPF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 N 119TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2011
Mailing Address - Country:US
Mailing Address - Phone:414-453-2972
Mailing Address - Fax:
Practice Address - Street 1:W172N11345 DIVISION RD
Practice Address - Street 2:APT. 4
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-2453
Practice Address - Country:US
Practice Address - Phone:262-250-1744
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112311163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39856800Medicaid