Healthcare Provider Details

I. General information

NPI: 1891130472
Provider Name (Legal Business Name): ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF ST FRANCIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S TAYLOR DR
SHEBOYGAN WI
53081-4773
US

IV. Provider business mailing address

PO BOX 19059
GREEN BAY WI
54307-9059
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax:
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREW J BAGNALL
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 920-496-4700