Healthcare Provider Details

I. General information

NPI: 1609042027
Provider Name (Legal Business Name): CESA #3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 INDUSTRIAL DR
FENNIMORE WI
53809-9702
US

IV. Provider business mailing address

1300 INDUSTRIAL DR
FENNIMORE WI
53809-9702
US

V. Phone/Fax

Practice location:
  • Phone: 608-822-3276
  • Fax: 608-822-3828
Mailing address:
  • Phone: 608-822-3276
  • Fax: 608-822-3828

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: LORETTA RIEMENAPP
Title or Position: FISCAL COORDINATOR
Credential:
Phone: 608-822-3276