Provider Demographics
NPI:1538540570
Name:WERONKA, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WERONKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 W LISBON RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2504
Mailing Address - Country:US
Mailing Address - Phone:262-754-3130
Mailing Address - Fax:262-754-3125
Practice Address - Street 1:12855 W LISBON RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2504
Practice Address - Country:US
Practice Address - Phone:262-754-3130
Practice Address - Fax:262-754-3125
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D1036616171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator