Healthcare Provider Details

I. General information

NPI: 1124075536
Provider Name (Legal Business Name): ASCENSION NE WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 MIDWAY PL
MENASHA WI
54952
US

IV. Provider business mailing address

1550 MIDWAY PL
MENASHA WI
54952-1165
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-1464
  • Fax: 920-720-1728
Mailing address:
  • Phone: 920-720-1464
  • Fax: 920-720-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number88
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUSAN DWYER
Title or Position: CFO
Credential:
Phone: 414-465-3093