Healthcare Provider Details

I. General information

NPI: 1164198503
Provider Name (Legal Business Name): LAUREN NICOLE WREN APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NICOLE BERG

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S MOORLAND RD
NEW BERLIN WI
53151-7494
US

IV. Provider business mailing address

4855 S MOORLAND RD
NEW BERLIN WI
53151-7494
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-7599
  • Fax:
Mailing address:
  • Phone: 262-432-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11213-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: