Healthcare Provider Details

I. General information

NPI: 1356691240
Provider Name (Legal Business Name): ANDREA L VERHAGEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 S KOELLER ST
OSHKOSH WI
54902-6186
US

IV. Provider business mailing address

411 LINCOLN ST
NEENAH WI
54956-2753
US

V. Phone/Fax

Practice location:
  • Phone: 920-223-2000
  • Fax:
Mailing address:
  • Phone: 920-727-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number136402
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: