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General NPI Number Information
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NPI Number | 1104264241
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Entity Type | Organization
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Legal Business Name | HEALTH OFFICE, CO.
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 815 CHAPIN ST
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4317
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Country | US
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Telephone | 715-834-6302
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Fax | 715-834-5046
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Provider Business Mailing Address
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Address Line | 1417 WILSON ST
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4808
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Country | US
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Telephone | 715-598-4141
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Fax | 715-832-0225
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. SUSAN D PECK
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Credential | RN PHD GNP-BC CHTP/I
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Telephone | 715-598-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 325-33
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License Number State | WI
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