Healthcare Provider Details

I. General information

NPI: 1417367277
Provider Name (Legal Business Name): GUNDERSEN CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E TAYLOR ST
PRAIRIE DU CHIEN WI
53821-2109
US

IV. Provider business mailing address

610 E TAYLOR ST
PRAIRIE DU CHIEN WI
53821-2109
US

V. Phone/Fax

Practice location:
  • Phone: 608-326-8911
  • Fax: 608-326-3324
Mailing address:
  • Phone: 608-326-8911
  • Fax: 608-326-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number9258-42
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TINA LECHNIR
Title or Position: VP CROSS-FUNCTIONAL CARE
Credential:
Phone: 608-775-2600