Healthcare Provider Details

I. General information

NPI: 1235056045
Provider Name (Legal Business Name): CALEB WARDENBURG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5413 CEDAR CREEK RD
GRAFTON WI
53024-9616
US

IV. Provider business mailing address

5413 CEDAR CREEK RD
GRAFTON WI
53024-9616
US

V. Phone/Fax

Practice location:
  • Phone: 203-456-4699
  • Fax:
Mailing address:
  • Phone: 203-456-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number70116635
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: