1003291154 NPI number — DR. ALEXANDRA A WENZEL DDS

Table of content: DR. ALEXANDRA A WENZEL DDS (NPI 1003291154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003291154 NPI number — DR. ALEXANDRA A WENZEL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENZEL
Provider First Name:
ALEXANDRA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003291154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE DU SAC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53578-0126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-643-3855
Provider Business Mailing Address Fax Number:
608-643-6295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8667 US HIGHWAY 42 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41091-8759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-384-0393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2015

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: 1223G0001X , with the licence number:  1001182 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 100102 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 30.025592 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 10204 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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