Healthcare Provider Details

I. General information

NPI: 1861539140
Provider Name (Legal Business Name): NORTHREACH HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 UNIVERSITY DR
MARINETTE WI
54143-5110
US

IV. Provider business mailing address

3120 RIVERSIDE AVE GATE B BUILDING 1
MARINETTE WI
54143-1123
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-5272
  • Fax: 715-735-0895
Mailing address:
  • Phone: 715-732-2075
  • Fax: 715-732-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL HIPKE
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 715-732-2078