Healthcare Provider Details

I. General information

NPI: 1073526661
Provider Name (Legal Business Name): GUNDERSEN CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

IV. Provider business mailing address

1836 SOUTH AVE
LA CROSSE WI
54601-5429
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-5595
  • Fax: 608-775-4445
Mailing address:
  • Phone: 608-775-5595
  • Fax: 608-775-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4884
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number263208
License Number StateMN

VIII. Authorized Official

Name: TINA LECHNIR
Title or Position: VP CROSS FUNCTION CARE
Credential:
Phone: 608-775-6200