Provider Demographics
NPI:1790117703
Name:WINGENDER, LAUREN B (WHNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:WINGENDER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:B
Other - Last Name:MEALIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2108 KOHLER MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3100
Mailing Address - Country:US
Mailing Address - Phone:920-458-9401
Mailing Address - Fax:
Practice Address - Street 1:2108 KOHLER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3100
Practice Address - Country:US
Practice Address - Phone:920-458-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWIN104369104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner