Kathleen M Wackerle, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1339 Issued in WI

Practice address

1833 Thorstrand Rd
Madison, WI 53705-1052

Phone

(608) 220-1646

NPI assigned

Mar 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1336100718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 THORSTRAND RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537051052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 THORSTRAND RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537051052",
            "telephone_number": "608-220-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACKERLE",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-28",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "93917",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa A Wachholz, CNM
• Rebecca A Wachowiak
• Courtney Wack, PT
• Emily Wacker
• Joel M. Wacker, M.D.
• Brian J Wackwitz, D.D.S.
• Donald L Wackwitz, M.D.
• Andrew J Waclawik, MD
• Gabrielle E Waclawik, MD
• Cheryle S Wade, SAC-IT

• Nurse Practitioner in Madison, WI
• Providers in Madison, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; 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.