Healthcare Provider Details

I. General information

NPI: 1275943243
Provider Name (Legal Business Name): ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SUPERIOR AVE
SHEBOYGAN WI
53081-1948
US

IV. Provider business mailing address

3100 SUPERIOR AVE
SHEBOYGAN WI
53081-1948
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-8300
  • Fax:
Mailing address:
  • Phone: 920-459-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREW BAGNALL
Title or Position: CEO
Credential:
Phone: 920-459-4705