Healthcare Provider Details

I. General information

NPI: 1336837400
Provider Name (Legal Business Name): LISA WENGEL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 PARK AVE
PLOVER WI
54467-4301
US

IV. Provider business mailing address

5318 DENTON PL
MADISON WI
53711-4325
US

V. Phone/Fax

Practice location:
  • Phone: 715-344-1260
  • Fax:
Mailing address:
  • Phone: 262-390-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1376633
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13766-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: