Healthcare Provider Details

I. General information

NPI: 1003148677
Provider Name (Legal Business Name): THE MONROE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 03/16/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVENUE
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVENUE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1128-39
License Number StateWI

VIII. Authorized Official

Name: MS. BRITTNEY MARGARET HANSEN
Title or Position: ATHLETIC TRAINER
Credential: LAT/ATC
Phone: 262-224-2664