Healthcare Provider Details

I. General information

NPI: 1396489837
Provider Name (Legal Business Name): DEBBIE PLENDL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 DEMING WAY
MADISON WI
53717-1917
US

IV. Provider business mailing address

308 N RIDGE DR
WAUNAKEE WI
53597-3127
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-2605
  • Fax:
Mailing address:
  • Phone: 608-345-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number128739-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: