Healthcare Provider Details

I. General information

NPI: 1568211100
Provider Name (Legal Business Name): HONEY SUCKLE BUSH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S CHERRY AVE
MARSHFIELD WI
54449-4245
US

IV. Provider business mailing address

1011 S CHERRY AVE
MARSHFIELD WI
54449-4245
US

V. Phone/Fax

Practice location:
  • Phone: 715-451-3251
  • Fax:
Mailing address:
  • Phone: 715-451-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES ETHER NORTON
Title or Position: DIRECTOR
Credential:
Phone: 715-451-3251