Healthcare Provider Details

I. General information

NPI: 1578323192
Provider Name (Legal Business Name): CHADD FRANCIS DEGRUSH PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 QUARRY PARK RD
MADISON WI
53718-7901
US

IV. Provider business mailing address

803 CLARA AVE
WISCONSIN DELLS WI
53965-7921
US

V. Phone/Fax

Practice location:
  • Phone: 844-767-3769
  • Fax:
Mailing address:
  • Phone: 608-345-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15179-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: