MR. BRENT ADAM ENGSTROM (NPI# 1558858936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558858936 |
| Entity Type | Individual |
| Full Name | MR. BRENT ADAM ENGSTROM |
| Practice Address |
1410 Nth 23rd Street Superior WI 54880 |
| Practice Telephone | 2185915016 |
| Mailing Telephone | 2185915016 |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2018-04-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | WI | Student, Health Care |
| Street Address |
1410 NTH 23RD STREET |
| City | SUPERIOR |
| State | WI |
| Zip Code | 54880 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427194 | Alana Catherine Sullivan | Speech-Language Pathologist | 25 N 25th Street E, Superior, WI 54880 | 2020-11-05 |
| 1710524970 | Sean Wiberg Peterson | Specialist/Technologist | 1810 Catlin Ave, Room 1246, Superior, WI 54880 | 2019-12-06 |
| 1558769125 | David Kroll | Specialist | Balknap & Catlin Aves., Superior, WI 54880 | 2014-12-15 |
| 1154670321 | Superior Treatment Center, Inc | Community/Behavioral Health | 1507 Tower Ave Ste 307, Superior, WI 54880 | 2012-09-04 |
| 1548551658 | Dionne Jeannine Corcoran | Midwife | 916 Hammond Ave Ste 222, Superior, WI 54880 | 2011-04-22 |
| 1821235433 | Lauren Ashley Miller | Speech-Language Pathologist | 35 N. 28th Street, Superior, WI 54880 | 2009-01-20 |
| 1528261989 | Stacy Ann Kennelly | Physical Therapist | 1612 N 37th Street, Superior, WI 54880 | 2007-06-06 |
| 1760564942 | James Henry Dobis | Family Medicine | 3520 Tower Avenue, Twin Ports Va Outpatient Clinic, Superior, WI 54880 | 2006-10-19 |
| 1134214398 | Kevin M Mikel | Dentist | 3312 Tower Avenue, Superior, WI 54880 | 2006-10-04 |
| 1710073218 | Kathy D Cox | Registered Nurse | Twin Ports Clinic Va, 3520 Tower Ave., Superior, WI 54880 | 2006-10-04 |
| Find all providers in zip 54880 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356730675 | Tatiana Warman | Student in an Organized Health Care Education/Training Program | 2245 Andrew Dr, Superior, CO 80027-8199 | 2015-01-12 |
| 1992329742 | Lia Maegi | Student in an Organized Health Care Education/Training Program | 35 N 28th St, Superior, WI 54880-5557 | 2020-06-07 |
| 1235558255 | Tejaswi Kompala | Student in an Organized Health Care Education/Training Program | 685 E Heartstrong St, Superior, CO 80027-8129 | 2014-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275130213 | Najla Ba Sharahil | Student in an Organized Health Care Education/Training Program | 600 Highland Avenue University of Wisconsin Hospitals A, Office H4/466, Madison, WI 53792-4108 | 2020-10-02 |
| 1730796079 | Brook Kmiecik | Student in an Organized Health Care Education/Training Program | 9198a Thrall Rd, Woodruff, WI 54568-9329 | 2020-09-30 |
| 1104432608 | Lauren Blunt | Student in an Organized Health Care Education/Training Program | 3913 E Hazelbranch Ln, Oak Creek, WI 53154-6637 | 2020-09-20 |
| 1639784598 | Charmaine Renee Farrille | Student in an Organized Health Care Education/Training Program | 6345 Pheasant Ln Apt 57c, Middleton, WI 53562-2242 | 2020-09-08 |
| 1407469505 | Abigail Koby | Student in an Organized Health Care Education/Training Program | 1802 E Sauk Rd Unit 8, Grafton, WI 53024-9750 | 2020-08-28 |
| 1427660141 | Taylor Rae Schneider | Student in an Organized Health Care Education/Training Program | 2635 S 91st St, West Allis, WI 53227-2422 | 2020-08-24 |
| 1841802840 | Brandi Hardy | Student in an Organized Health Care Education/Training Program | 1477 S Knowles Ave Ste 120, New Richmond, WI 54017-2543 | 2020-08-20 |
| 1588275226 | Benjamin N Wasserman | Student in an Organized Health Care Education/Training Program | 3487 N Lake Dr, Milwaukee, WI 53211-2919 | 2020-08-16 |
| 1902416969 | Cynthia Iradukunda | Student in an Organized Health Care Education/Training Program | University of Wisconsin School of Medicine and Public H, 600 Highland Ave, B6/319, Madison, WI 53792 | 2020-08-05 |
| 1144830480 | Eve E Viner | Student in an Organized Health Care Education/Training Program | 122 10th St S, La Crosse, WI 54601-4113 | 2020-08-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.