Healthcare Provider Details

I. General information

NPI: 1649506080
Provider Name (Legal Business Name): ONEIDA NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AIRPORT RD
ONEIDA WI
54155-0935
US

IV. Provider business mailing address

PO BOX 365
ONEIDA WI
54155-0365
US

V. Phone/Fax

Practice location:
  • Phone: 920-869-2711
  • Fax:
Mailing address:
  • Phone: 920-869-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number133891-030
License Number StateWI

VIII. Authorized Official

Name: DEBBIE DANFORTH
Title or Position: DIRECTOR OF OPERATIONS
Credential: RN, BSN
Phone: 920-869-2711