Healthcare Provider Details

I. General information

NPI: 1982096772
Provider Name (Legal Business Name): OAKLEAF CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 09/21/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 STEIN BLVD
EAU CLAIRE WI
54701-6946
US

IV. Provider business mailing address

719 W HAMILTON AVE STE B
EAU CLAIRE WI
54701-6970
US

V. Phone/Fax

Practice location:
  • Phone: 715-830-0732
  • Fax: 715-830-5487
Mailing address:
  • Phone: 715-552-9784
  • Fax: 715-835-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRIS R LONGBELLA
Title or Position: DIRECTOR
Credential: MD
Phone: 715-836-9242