1023110319 NPI number — MRS. ANN MARIE WELLMAN-KRAUSE MSW

Table of content: MRS. ANN MARIE WELLMAN-KRAUSE MSW (NPI 1023110319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023110319 NPI number — MRS. ANN MARIE WELLMAN-KRAUSE MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLMAN-KRAUSE
Provider First Name:
ANN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLMAN-KRAUSE
Provider Other First Name:
ANN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1023110319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2717 N GRANDVIEW BLVD
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53188-1672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-544-6486
Provider Business Mailing Address Fax Number:
262-544-6377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2717 N GRANDVIEW BLVD
Provider Second Line Business Practice Location Address:
#303
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-544-6486
Provider Business Practice Location Address Fax Number:
262-544-6377
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  436123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39255400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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