Healthcare Provider Details

I. General information

NPI: 1124207741
Provider Name (Legal Business Name): NORTHLAND PINES SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PLEASURE ISLAND RD
EAGLE RIVER WI
54521-8980
US

IV. Provider business mailing address

1800 PLEASURE ISLAND RD
EAGLE RIVER WI
54521-8980
US

V. Phone/Fax

Practice location:
  • Phone: 715-479-6487
  • Fax: 715-479-7633
Mailing address:
  • Phone: 715-479-6487
  • Fax: 715-479-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MIKE RICHIE
Title or Position: DISTRICT ADMINISTRATOR
Credential:
Phone: 715-479-6487