Healthcare Provider Details

I. General information

NPI: 1659759611
Provider Name (Legal Business Name): HARLEY WENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 STATE ST
LA CROSSE WI
54601-3742
US

IV. Provider business mailing address

1016 11 1/2 ST SE
ROCHESTER MN
55904-5026
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-8000
  • Fax:
Mailing address:
  • Phone: 507-259-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: