Healthcare Provider Details

I. General information

NPI: 1073653523
Provider Name (Legal Business Name): MONROE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-1175
  • Fax: 608-324-1214
Mailing address:
  • Phone: 608-324-1175
  • Fax: 608-324-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1201-026
License Number StateWI

VIII. Authorized Official

Name: MRS. SANDRA NELSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 608-324-1175