Provider Demographics
NPI:1487118881
Name:WESSBERG, DEBORAH (BSN, RN,CDE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WESSBERG
Suffix:
Gender:F
Credentials:BSN, RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOODLAND PRIME
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4476
Mailing Address - Country:US
Mailing Address - Phone:414-777-1206
Mailing Address - Fax:
Practice Address - Street 1:200 WOODLAND PRIME
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4476
Practice Address - Country:US
Practice Address - Phone:414-777-1206
Practice Address - Fax:414-777-3767
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139940-30163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI139940-30OtherREGISTERED NURSE