Healthcare Provider Details

I. General information

NPI: 1285948315
Provider Name (Legal Business Name): LISA A WENZEL M.S., CES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BELTLINE HWY SUITE 207
MADISON WI
53713-2318
US

IV. Provider business mailing address

2501 W BELTLINE HWY SUITE 207
MADISON WI
53713-2318
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6102
  • Fax: 608-417-5770
Mailing address:
  • Phone: 608-417-6102
  • Fax: 608-417-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: