MEDICARE: CHARLES BEHRENS NURSE PRACTITIONER

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	363LP2300X	Primary Care Nurse Practitioner	1727133	WI

General Provider Information

NPI Number	:	1629957832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BEHRENS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	710 RIDGE ST APT 206
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3641
Country	:	US
Telephone Number	:	414-366-6015
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 W MADISON ST
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-1379
Country	:	US
Telephone Number	:	920-390-7290
Fax Number	:

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

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	09/01/2025

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