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General NPI Number Information
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NPI Number | 1528011657
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Entity Type | Organization
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Legal Business Name | VILLAGE OF CLEAR LAKE
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 457 3RD AVE
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City | CLEAR LAKE
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State | WI
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Zip | 54005-8905
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Country | US
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Telephone | 715-263-2804
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | CLEAR LAKE
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State | WI
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Zip | 54005-0215
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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 | DIRECTOR/RN
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Name | MISTY WOOD
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Credential | RN
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Telephone | 602-670-1386
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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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