Provider Demographics
NPI:1780356337
Name:WETTER, TORY LEE (NP)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:LEE
Last Name:WETTER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HUNTERS GLEN LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9484
Mailing Address - Country:US
Mailing Address - Phone:608-642-1457
Mailing Address - Fax:
Practice Address - Street 1:405 HUNTERS GLEN LN
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9484
Practice Address - Country:US
Practice Address - Phone:608-642-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI222688-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse