Basic Information
| Provider Information | |||||||||
| NPI: | 1053887943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | DENITA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | APNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 JOHN Q HAMMONS DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537171967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084102700 | ||||||||
| FaxNumber: | 6084102905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 JOHN Q HAMMONS DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537171967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084102700 | ||||||||
| FaxNumber: | 6084102905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2018 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2017008379 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 8365-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1053887943 | 05 | WI | MEDICAID |