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General NPI Number Information
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NPI Number | 1235281189
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Entity Type | Organization
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Legal Business Name | NORTHERN PINES EAR NOSE AND THROAT SC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 4956 BULLIS FARM RD
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-831-3300
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Fax | 715-831-7958
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Provider Business Mailing Address
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Address Line | 4956 BULLIS FARM RD
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-831-3300
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Fax | 715-831-7958
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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | MICHELLE LEE FACER
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Credential | DO
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Telephone | 715-831-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 44656
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License Number State | WI
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