Provider Demographics
NPI:1437186665
Name:WENGELER, KIRSTEN ANN (APNP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANN
Last Name:WENGELER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ANN
Other - Last Name:ENGEBRETSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7289
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-7070
Mailing Address - Country:US
Mailing Address - Phone:920-729-7105
Mailing Address - Fax:
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Practice Address - Street 2:SUITE 130
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2721
Practice Address - Country:US
Practice Address - Phone:920-729-7105
Practice Address - Fax:920-720-2153
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1983033 APNP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43954500Medicaid
WI43954500Medicaid
P45325Medicare UPIN