Provider Demographics
NPI:1720366032
Name:WECH, CARLA J (NP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:WECH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:723 S WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:WI
Practice Address - Zip Code:54162-9303
Practice Address - Country:US
Practice Address - Phone:920-822-1100
Practice Address - Fax:920-822-5731
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI481-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1720366032Medicaid
F0711219OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
WI1720366032Medicaid
WI073100058Medicare Oscar/Certification
WI100200074Medicare Oscar/Certification
WI590050057Medicare Oscar/Certification
WI071700062Medicare Oscar/Certification
WI073050058Medicare Oscar/Certification