Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 100102 | CA |
N | 213EG0000X | General Practice | 100102 | CA |
N | 1223G0001X | General Practice | 1001182 | WI |
N | 213EG0000X | General Practice | 1001182 | WI |
Y | 1223G0001X | General Practice | 10204 | KY |
Y | 213EG0000X | General Practice | 10204 | KY |
N | 1223G0001X | General Practice | 30.025592 | OH |
N | 213EG0000X | General Practice | 30.025592 | OH |
NPI | 1003291154 |
---|---|
Provider Name | Dr. Alexandra A Wenzel |
First Address | Prairie Du Sac, WI 53578-0126 |
Second Address | Union, KY 41091-8759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2015 |
Last Update Date | 07/11/2018 |