Healthcare Provider Details

I. General information

NPI: 1902629363
Provider Name (Legal Business Name): SLEEP HEALTH WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 17TH AVE STE 201
WAUSAU WI
54401-4225
US

IV. Provider business mailing address

1052 BEL AIRE CT
GREEN BAY WI
54304-5015
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-3933
  • Fax:
Mailing address:
  • Phone: 920-499-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACY ADAMS
Title or Position: MEDICAL CLINIC COORDINATOR
Credential:
Phone: 920-425-4140