Healthcare Provider Details

I. General information

NPI: 1114719937
Provider Name (Legal Business Name): CLAIRE NATE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MONROE AVE
GREEN BAY WI
54301-4054
US

IV. Provider business mailing address

1600 MICHIGAN AVE
WISCONSIN DELLS WI
53965-1321
US

V. Phone/Fax

Practice location:
  • Phone: 608-432-3774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001832-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: