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General NPI Number Information
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NPI Number | 1578323192
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Entity Type | Individual
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Provider Name | CHADD FRANCIS DEGRUSH PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 5401 QUARRY PARK RD
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City | MADISON
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State | WI
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Zip | 53718-7901
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Country | US
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Telephone | 844-767-3769
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Fax |
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Provider Business Mailing Address
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Address Line | 803 CLARA AVE
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City | WISCONSIN DELLS
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State | WI
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Zip | 53965-7921
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Country | US
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Telephone | 608-345-0641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 15179-33
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License Number State | WI
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