Provider Demographics
NPI:1205215431
Name:WERMUND, MCKENZI (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MCKENZI
Middle Name:
Last Name:WERMUND
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:WI
Mailing Address - Zip Code:53924-0124
Mailing Address - Country:US
Mailing Address - Phone:608-495-0049
Mailing Address - Fax:
Practice Address - Street 1:145 COUNTY HWY V
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:WI
Practice Address - Zip Code:53924-7169
Practice Address - Country:US
Practice Address - Phone:608-495-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program