Individual
LISA R WENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
W244N4850 SWAN RD, PEWAUKEE, WI 53072-1402
(414) 333-4128
Mailing address
W244N4850 SWAN RD, PEWAUKEE, WI 53072-1402
(414) 333-4128
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
26572-81
WI
Other
Enumeration date
01/24/2019
Last updated
01/24/2019
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