Provider Demographics
NPI:1720579287
Name:WENTZEL, MADELEINE (DNP, APNP, CNM, FNP)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:DNP, APNP, CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S PARK ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2168
Mailing Address - Country:US
Mailing Address - Phone:608-251-6546
Mailing Address - Fax:
Practice Address - Street 1:2222 S PARK ST STE 210
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:608-251-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7602-33363L00000X
IL209.028531363L00000X
WI148932367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner