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General NPI Number Information
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NPI Number | 1821989872
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Entity Type | Organization
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Legal Business Name | WESTERN WISCONSIN UROLOGY
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 3217 STEIN BLVD
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6946
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Country | US
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Telephone | 715-835-6548
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Fax | 715-835-7708
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Provider Business Mailing Address
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Address Line | 3217 STEIN BLVD
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6946
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Country | US
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Telephone | 715-835-6548
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Fax | 715-835-7708
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LYNNSI GULLICKSRUD
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Credential |
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Telephone | 715-835-6548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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