Healthcare Provider Details

I. General information

NPI: 1780640250
Provider Name (Legal Business Name): CITY OF PRINCETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 WEST MAIN ST
PRINCETON WI
54968
US

IV. Provider business mailing address

PO BOX 53 438 WEST MAIN ST
PRINCETON WI
54968
US

V. Phone/Fax

Practice location:
  • Phone: 920-295-6612
  • Fax: 920-295-3441
Mailing address:
  • Phone: 920-295-6612
  • Fax: 920-295-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYLE R NICKEL
Title or Position: AMBULANCE SECRETARY
Credential:
Phone: 920-295-6612