=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073447884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREE CLINIC OF PIERCE & ST. CROIX COUNTIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2026
-----------------------------------------------------
Last Update Date | 06/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1629 E DIVISION ST
-----------------------------------------------------
City | RIVER FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54022-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-307-3948
-----------------------------------------------------
Fax | 715-307-6005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1629 E DIVISION ST
-----------------------------------------------------
City | RIVER FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54022-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-307-3948
-----------------------------------------------------
Fax | 715-307-6005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSING SUPERVISOR
-----------------------------------------------------
Name | JENA MOST
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 651-503-0639
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------