Bruce E Weffenstette, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

21888 Issued in WI

Practice address

1300 South Dr.
Winnebago, WI 54985-0009

Phone

(920) 235-4910

Fax

(920) 236-2931

NPI assigned

Dec 11, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Winnebago Mental Health Institute

  • Psychiatric Hospital
  • Winnebago, WI
  • NPI 1164516506
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1083774830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 SOUTH DR.",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "549850009",
            "telephone_number": "920-235-4910",
            "fax_number": "920-236-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SOUTH DR.",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "549850009",
            "telephone_number": "920-235-4910",
            "fax_number": "920-236-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEFFENSTETTE",
        "first_name": "BRUCE",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "21888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30425200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sylvester A Szadkowski, M.D.
• Julie Ann Thiel, BS PHARM, BCPP
• Laura Jo Thompson, RPH
• Cherish Torrence, APNP
• John Edward Vickman, M.D
• Jared J West, MD
• Candace Whitman, APNP
• Winnebago County
• Winnebago Mental Health Institute
• Wisconsin Resource Center

• Psychiatry Physician in Winnebago, WI
• Providers in Winnebago, WI by specialty
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.