Healthcare Provider Details

I. General information

NPI: 1700447992
Provider Name (Legal Business Name): PATRICIA MARIE PERDZOCK-HAAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-4908
  • Fax: 608-890-2203
Mailing address:
  • Phone: 608-265-4908
  • Fax: 608-890-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number171591
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: