Healthcare Provider Details

I. General information

NPI: 1164265096
Provider Name (Legal Business Name): PATRIOT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W2058 SPRING CREEK RD
DURAND WI
54736-8107
US

IV. Provider business mailing address

PO BOX 13
WABASHA MN
55981-0013
US

V. Phone/Fax

Practice location:
  • Phone: 715-495-0404
  • Fax:
Mailing address:
  • Phone: 715-279-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALISON DELONG
Title or Position: OWNER
Credential:
Phone: 715-495-0404