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General NPI Number Information
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NPI Number | 1679545917
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Entity Type | Organization
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Legal Business Name | FOND DU LAC COUNTY
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 160 S MACY ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4241
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Country | US
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Telephone | 920-929-3085
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Fax | 920-929-3102
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Provider Business Mailing Address
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Address Line | 160 S MACY ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4241
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Country | US
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Telephone | 920-929-3085
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Fax | 920-929-3102
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Authorized Official
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Title or Position | FOND DU LAC COUNTY HEALTH OFFICER
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Name | KIMBERLY MUELLER
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Credential | RN, MSN
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Telephone | 920-929-3085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 54
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License Number State | WI
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