Provider Demographics
NPI:1922774389
Name:MOHR, WENDY LYNN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:MOHR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4279
Mailing Address - Country:US
Mailing Address - Phone:920-479-8545
Mailing Address - Fax:
Practice Address - Street 1:801 YORKSHIRE RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4279
Practice Address - Country:US
Practice Address - Phone:920-479-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11058-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily