Healthcare Provider Details

I. General information

NPI: 1194658773
Provider Name (Legal Business Name): ANNE LECLAIRE-THOMA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 N MONROE ST
WATERLOO WI
53594-1171
US

IV. Provider business mailing address

7340 WILBURN RD
SUN PRAIRIE WI
53590-9608
US

V. Phone/Fax

Practice location:
  • Phone: 920-478-2168
  • Fax:
Mailing address:
  • Phone: 608-332-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number107312
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: