Individual provider Active NPI

Judy Yakich Wentland, NP

  • Women's Health Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1255426789
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
911033 Issued in WI
Practice address
1039 West Mason Street
Executive Office Suites
Green Bay, WI 54303
Phone
(920) 965-7716
NPI assigned
Oct 3, 2006
Last updated
Apr 30, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 911033 WI Primary

Addresses

Primary practice location

1039 West Mason Street
Executive Office Suites
Green Bay, WI 54303

Mailing address

2643 Libal St
Ste C
Green Bay, WI 54301-2885
Phone (920) 388-0560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
911WIMDPhysician Assistant
911033WIMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prevea Regional Services, Inc. Past Accepting new patients
Aurora Medical Center of Oshkosh, Inc Past Accepting new patients
The Sleep Wellness Institute Inc Past Accepting new patients
The Sleep Wellness Institute Inc PastSince Mar 4, 2021 Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1255426789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2643 LIBAL ST",
            "address_2": "STE C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012885",
            "telephone_number": "920-388-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1039 WEST MASON STREET",
            "address_2": "EXECUTIVE OFFICE SUITES",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54303",
            "telephone_number": "920-965-7716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENTLAND",
        "first_name": "JUDY",
        "middle_name": "YAKICH",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "WI",
            "license": "911033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; 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.