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General NPI Number Information
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NPI Number | 1891130472
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Entity Type | Organization
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Legal Business Name | ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF ST FRANCIS
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 1020 S TAYLOR DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4773
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19059
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City | GREEN BAY
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State | WI
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Zip | 54307-9059
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | ANDREW J BAGNALL
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Credential |
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Telephone | 920-496-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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