Healthcare Provider Details

I. General information

NPI: 1063550820
Provider Name (Legal Business Name): CITY OF WASHBURN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WASHINGTON AVE.
WASHBURN WI
54891
US

IV. Provider business mailing address

119 WASHINGTON AVE. P.O BOX 638
WASHBURN WI
54891
US

V. Phone/Fax

Practice location:
  • Phone: 715-373-6160
  • Fax:
Mailing address:
  • Phone: 715-373-6160
  • Fax: 715-373-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number41323800
License Number StateWI

VIII. Authorized Official

Name: TAMMY L. DEMARS
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 715-373-6160