Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 47144 | MN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 50762-020 | WI |
NPI | 1235349077 |
---|---|
Provider Name | Dr. Ellen Turner Wenberg |
First Address | Waupaca, WI 54981-1941 |
Second Address | Waupaca, WI 54981-1941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 22/03/2012 |