Healthcare Provider Details

I. General information

NPI: 1336434406
Provider Name (Legal Business Name): PEPIN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 7TH AVE W
DURAND WI
54736-1628
US

IV. Provider business mailing address

PO BOX 39
DURAND WI
54736-0039
US

V. Phone/Fax

Practice location:
  • Phone: 715-672-8941
  • Fax: 715-672-8593
Mailing address:
  • Phone: 715-672-8941
  • Fax: 715-672-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER CHOUINARD
Title or Position: FISCAL MANAGER
Credential:
Phone: 715-672-8941