Healthcare Provider Details

I. General information

NPI: 1225587512
Provider Name (Legal Business Name): SANDRA RENEE PELNAR C.N.M., W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S VANBUREN ST SUITE 101
GREEN BAY WI
54301
US

IV. Provider business mailing address

1400 BELLINGER ST
EAU CLAIRE WI
54703-5222
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3420
  • Fax: 920-338-6859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number7297-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number148924-32
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: