Healthcare Provider Details

I. General information

NPI: 1841112877
Provider Name (Legal Business Name): DORISSA DENURE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPRINGDALE ST
MOUNT HOREB WI
53572-2067
US

IV. Provider business mailing address

6569 SPORE RD
ARGYLE WI
53504-9545
US

V. Phone/Fax

Practice location:
  • Phone: 608-437-9160
  • Fax: 608-437-9166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23568-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: