Healthcare Provider Details

I. General information

NPI: 1114342847
Provider Name (Legal Business Name): SLEEP APNEA CARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N 17TH AVE STE 100
WAUSAU WI
54401-4287
US

IV. Provider business mailing address

305 S 18TH AVE SUITE 300
WAUSAU WI
54401-4208
US

V. Phone/Fax

Practice location:
  • Phone: 715-218-4900
  • Fax: 715-355-5790
Mailing address:
  • Phone: 715-218-4900
  • Fax: 715-355-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3272
License Number StateWI

VIII. Authorized Official

Name: RODNEY EARL WILLEY
Title or Position: OWNER
Credential: DDS
Phone: 309-376-8385