Healthcare Provider Details

I. General information

NPI: 1831246487
Provider Name (Legal Business Name): NORTHEASTERN WISCONSIN WOMENS HEALTH CARE ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S MAIN ST SUITE 2
OCONTO FALLS WI
54154-1282
US

IV. Provider business mailing address

835 S MAIN ST SUITE 2
OCONTO FALLS WI
54154-1282
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-9995
  • Fax: 920-846-8031
Mailing address:
  • Phone: 920-846-9995
  • Fax: 920-846-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50013
License Number StateWI

VIII. Authorized Official

Name: DR. JUDITH E BOWERS
Title or Position: PRESIDENT
Credential: DO
Phone: 920-846-9995