Provider Demographics
NPI:1881760163
Name:WAEDEKIN, BARBARA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WAEDEKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:SAPIENZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4351 WEST COLLEGE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914
Mailing Address - Country:US
Mailing Address - Phone:920-843-5658
Mailing Address - Fax:920-843-5685
Practice Address - Street 1:4351 WEST COLLEGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914
Practice Address - Country:US
Practice Address - Phone:920-843-5660
Practice Address - Fax:920-843-5685
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36810-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42139300Medicaid
WI42139300Medicaid
001784287Medicare ID - Type Unspecified
WI42139300Medicaid