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General NPI Number Information
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NPI Number | 1114970159
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Entity Type | Organization
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Legal Business Name | TOWN OF BRAZEAU
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 12071 PARKWAY RD
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City | POUND
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State | WI
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Zip | 54161-8707
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Country | US
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Telephone | 920-897-2793
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Fax |
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Provider Business Mailing Address
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Address Line | 9151 GRAVEL LN
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City | LENA
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State | WI
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Zip | 54139-9774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUE KANACK
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Credential |
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Telephone | 920-897-2793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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