MEDICARE: THERESA M LENAGHAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2289-033	WI

General Provider Information

NPI Number	:	1295784460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA M LENAGHAN NP

Provider Business Mailing Address
First Line	:	6121 SHOOTING STAR TRL
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 SHOOTING STAR TRL
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8923
Country	:	US
Telephone Number	:	608-333-8921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/03/2024

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