Provider Demographics
NPI:1437132701
Name:WERNER, LEE A (NP)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:WERNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 REED AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2020
Mailing Address - Country:US
Mailing Address - Phone:920-320-8600
Mailing Address - Fax:920-320-8662
Practice Address - Street 1:339 REED AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2020
Practice Address - Country:US
Practice Address - Phone:920-320-8600
Practice Address - Fax:920-320-8662
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1620363L00000X
WI1620-003364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43899800Medicaid
WI43899800Medicaid