Provider Demographics
NPI:1629957832
Name:BEHRENS, CHARLES (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:A
Other - Last Name:BEHRENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:710 RIDGE ST APT 206
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3641
Mailing Address - Country:US
Mailing Address - Phone:414-366-6015
Mailing Address - Fax:
Practice Address - Street 1:801 W MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-1379
Practice Address - Country:US
Practice Address - Phone:920-390-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1727133363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care