Healthcare Provider Details

I. General information

NPI: 1639266596
Provider Name (Legal Business Name): MISS ANDREA LYNN WROBLEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11649 N PORT WASHINGTON RD
MEQUON WI
53092
US

IV. Provider business mailing address

218 S JEFFERSON ST
WATERFORD WI
53185
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-8022
  • Fax: 262-241-8047
Mailing address:
  • Phone: 262-374-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: