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General NPI Number Information
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NPI Number | 1851048904
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Entity Type | Individual
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Provider Name | EMILY JOHANNSEN CROES P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2321 STOUT RD
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City | MENOMONIE
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State | WI
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Zip | 54751-7003
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Country | US
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Telephone | 715-233-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 157-838-5222
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5772
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License Number State | WI
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