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General NPI Number Information
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NPI Number | 1750331807
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Entity Type | Organization
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Legal Business Name | GRANT REGIONAL FAMILY PRACTICE
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 507 S MONROE ST
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City | LANCASTER
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State | WI
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Zip | 53813-2054
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Country | US
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Telephone | 608-723-3293
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Fax | 608-723-3281
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Provider Business Mailing Address
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Address Line | 507 S MONROE ST
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City | LANCASTER
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State | WI
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Zip | 53813-2054
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Country | US
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Telephone | 608-723-3293
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Fax | 608-723-3281
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Authorized Official
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Title or Position | CEO
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Name | NICOLE CLAPP
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Credential |
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Telephone | 608-723-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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