Provider Demographics
NPI:1568776482
Name:MERKEL, DANA MAE (NP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MAE
Last Name:MERKEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MAE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 777
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-649-3530
Mailing Address - Fax:414-649-5769
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 777
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-649-3530
Practice Address - Fax:414-649-5769
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4105-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily