1487922613 NPI number — MRS. RENEE ROCHELLE WUENSCH COTA

Table of content: MRS. RENEE ROCHELLE WUENSCH COTA (NPI 1487922613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487922613 NPI number — MRS. RENEE ROCHELLE WUENSCH COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WUENSCH
Provider First Name:
RENEE
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
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:
1487922613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 EAGLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54653-9709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-486-4434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2448 S 102ND ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53227-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-877-7018
Provider Business Practice Location Address Fax Number:
414-350-4260
Provider Enumeration Date:
12/02/2011

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: 224Z00000X , with the licence number:  1760-27 , 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)





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