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General NPI Number Information
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NPI Number | 1912078718
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Entity Type | Organization
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Legal Business Name | EAU CLAIRE GI ASSOCIATES SC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 4109 OAKWOOD HILLS PARKWAY
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City | EAU CLAIRE
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State | WI
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Zip | 54701-8888
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Country | US
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Telephone | 715-552-7303
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Fax | 715-552-7355
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Provider Business Mailing Address
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Address Line | 4109 OAKWOOD HILLS PARKWAY
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City | EAU CLAIRE
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State | WI
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Zip | 54701-8888
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Country | US
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Telephone | 715-552-7303
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Fax | 715-552-7355
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | AMY FOGELTANZ
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Credential |
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Telephone | 715-552-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family 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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 37801-020
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License Number State | WI
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