Provider Demographics
NPI:1063462687
Name:WENSZELL, JOSEPH A (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:WENSZELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-433-3605
Mailing Address - Fax:920-433-3589
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3605
Practice Address - Fax:920-433-3589
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527207367500000X
TXAP106187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
45577OtherAMERICAN ASSOCIATION OF NURSE ANESTHETISTS
TX430061211OtherMEDICARE PART B RAILROAD
TX003440702Medicaid
TXS30783Medicare UPIN
WIK400274458Medicare Oscar/Certification