Healthcare Provider Details

I. General information

NPI: 1568228690
Provider Name (Legal Business Name): ERIC MICHAEL HORRELL APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N GREEN BAY RD
NEENAH WI
54956-1954
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-6088
  • Fax:
Mailing address:
  • Phone: 920-729-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1496733
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: