Healthcare Provider Details

I. General information

NPI: 1356254239
Provider Name (Legal Business Name): WILLIAM J MOREAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 JEFFERSON AVE
NIAGARA WI
54151-1221
US

IV. Provider business mailing address

700 JEFFERSON AVE
NIAGARA WI
54151-1221
US

V. Phone/Fax

Practice location:
  • Phone: 715-251-4541
  • Fax:
Mailing address:
  • Phone: 715-988-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number179598-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: