Healthcare Provider Details

I. General information

NPI: 1437132701
Provider Name (Legal Business Name): LEE A WERNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 REED AVE
MANITOWOC WI
54220-2020
US

IV. Provider business mailing address

339 REED AVE
MANITOWOC WI
54220-2020
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-8600
  • Fax: 920-320-8662
Mailing address:
  • Phone: 920-320-8600
  • Fax: 920-320-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1620
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number1620-003
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier43899800
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: