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General NPI Number Information
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NPI Number | 1952027609
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Entity Type | Organization
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Legal Business Name | LA CLINICA DE LOS CAMPESINOS, INC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 2501 MAIN ST
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City | STEVENS POINT
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State | WI
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Zip | 54481-4000
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Country | US
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Telephone | 920-647-8126
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Fax | 920-647-8133
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Provider Business Mailing Address
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Address Line | PO BOX 1440
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City | WAUTOMA
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State | WI
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Zip | 54982-1440
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Country | US
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Telephone | 920-787-5514
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Fax | 920-787-4737
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Authorized Official
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Title or Position | ENROLLMENT AND CONTRACT SPECIALIST
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Name | ERIN LAMORE
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Credential |
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Telephone | 920-787-9459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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