Provider Demographics
NPI:1053362947
Name:ETTER, NANCY J (PA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:ETTER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC NEUROSURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6435
Mailing Address - Fax:414-955-0131
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC NEUROSURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6435
Practice Address - Fax:414-955-0131
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI298363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053362947Medicaid
000011354OtherHUMANA
WI1053362947Medicaid
WI73601 2022Medicare PIN
WI68086 0767Medicare PIN