Provider Demographics
NPI:1336540418
Name:ENTERS, ANDREA R (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:ENTERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RUTH
Other - Last Name:BUCHBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N54W23859 JOHANSSEN CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2142
Mailing Address - Country:US
Mailing Address - Phone:414-708-8824
Mailing Address - Fax:
Practice Address - Street 1:N54W23859 JOHANSSEN CT
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2142
Practice Address - Country:US
Practice Address - Phone:414-708-8824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5987363LG0600X, 363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100040273Medicaid