Healthcare Provider Details

I. General information

NPI: 1457184970
Provider Name (Legal Business Name): EMILY ELIZABETH WACHTENDONK DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W AMERICAN DR
NEENAH WI
54956-1993
US

IV. Provider business mailing address

265 FARMSTEAD DR
SLINGER WI
53086-9288
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-9373
  • Fax: 920-720-7392
Mailing address:
  • Phone: 920-850-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15745-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: