Healthcare Provider Details

I. General information

NPI: 1962636795
Provider Name (Legal Business Name): JANINE RENE WURZER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANINE RENE CROSS

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 08/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E ANN ST
WEYAUWEGA WI
54983
US

IV. Provider business mailing address

309 E ANN ST
WEYAUWEGA WI
54983-8540
US

V. Phone/Fax

Practice location:
  • Phone: 920-419-5512
  • Fax:
Mailing address:
  • Phone: 920-419-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number82360-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: