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General NPI Number Information
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NPI Number | 1811167729
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 630 HILLTOP CIR CREST WELLNESS CENTER
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6196
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Country | US
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Telephone | 715-836-4311
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Fax | 715-836-5979
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Provider Business Mailing Address
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Address Line | 630 HILLTOP CIR CREST WELLNESS CENTER
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6196
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Country | US
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Telephone | 715-836-4311
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Fax | 715-836-5979
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. LAURA G. CHELLMAN
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Credential | RN, C, MSN
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Telephone | 715-836-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 42012200
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License Number State | WI
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