Provider Demographics
NPI:1013750728
Name:WANKERL-ESTRADA, SAMARA ELENA (CNA)
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:ELENA
Last Name:WANKERL-ESTRADA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:E
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:182 9TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2414
Mailing Address - Country:US
Mailing Address - Phone:608-434-3325
Mailing Address - Fax:
Practice Address - Street 1:5395 E CHERYL PKWY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5395
Practice Address - Country:US
Practice Address - Phone:608-276-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI035194301805376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide