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General NPI Number Information
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NPI Number | 1376208868
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Entity Type | Organization
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Legal Business Name | FOREFRONT DERMATOLOGY, S.C.
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 830 AINSWORTH DR
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City | PRESCOTT
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State | AZ
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Zip | 86301-1630
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Country | US
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Telephone | 928-777-5800
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Fax | 928-776-0405
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETSY J WERNLI
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Credential | MD
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Telephone | 920-482-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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Taxonomy #7
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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