Healthcare Provider Details

I. General information

NPI: 1992229686
Provider Name (Legal Business Name): MICHELE DANETTE SKOGLUND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N BALLARD RD STE B
APPLETON WI
54911-9002
US

IV. Provider business mailing address

3210 E CANVASBACK LN
APPLETON WI
54913-8011
US

V. Phone/Fax

Practice location:
  • Phone: 920-753-8816
  • Fax:
Mailing address:
  • Phone: 920-731-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number149508-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: