Provider Demographics
NPI:1336837400
Name:WENGEL, LISA (APNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WENGEL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 DENTON PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-4325
Mailing Address - Country:US
Mailing Address - Phone:262-390-0164
Mailing Address - Fax:
Practice Address - Street 1:1767 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-4301
Practice Address - Country:US
Practice Address - Phone:715-344-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1376633363LF0000X
WI13766-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily