Basic Information
| Provider Information | |||||||||
| NPI: | 1578202867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDVOGEL | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | TERRENCE | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | W19205 COUNTY ROAD Z | ||||||||
| Address2: | |||||||||
| City: | BIRNAMWOOD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544148838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152194130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3605 STEWART AVE | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544014938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158470800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 19390230 | WI | N | Nursing Service Providers | Registered Nurse | 363L00000X | 12060-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.