Healthcare Provider Details

I. General information

NPI: 1114092368
Provider Name (Legal Business Name): PARKINSON DERMATOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 TIMBERLANE RD
SPOONER WI
54801-9687
US

IV. Provider business mailing address

114 TIMBERLANE RD
SPOONER WI
54801-9687
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-3766
  • Fax: 715-635-3711
Mailing address:
  • Phone: 715-635-3766
  • Fax: 715-635-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number36649020
License Number StateWI

VIII. Authorized Official

Name: DR. KATHERINE E PARKINSON
Title or Position: PRESIDENT
Credential: MD
Phone: 715-635-3766