Healthcare Provider Details

I. General information

NPI: 1174152987
Provider Name (Legal Business Name): CHRISTOPHER HARRY JOSEPH NYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PINE RIDGE BLVD
WAUSAU WI
54401-4120
US

IV. Provider business mailing address

5318 FROSTY LN
MADISON WI
53705-2735
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2121
  • Fax:
Mailing address:
  • Phone: 630-699-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number77587-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number77587-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: