Healthcare Provider Details

I. General information

NPI: 1154318616
Provider Name (Legal Business Name): ERIC NUEBEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 E WOODLAND AVE
BARRON WI
54812-1765
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-1510
US

V. Phone/Fax

Practice location:
  • Phone: 715-537-3166
  • Fax:
Mailing address:
  • Phone: 715-838-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1270
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: