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General NPI Number Information
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NPI Number | 1952174096
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Entity Type | Organization
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Legal Business Name | CHC OF WISCONSIN
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 1120 E NAWADA ST
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City | APPLETON
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State | WI
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Zip | 54911-5271
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Country | US
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Telephone | 920-810-2372
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 E NAWADA ST
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City | APPLETON
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State | WI
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Zip | 54911-5271
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Country | US
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Telephone | 920-810-2372
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Fax |
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Authorized Official
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Title or Position | ADMIN BILLING
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Name | MICHELE DIGERONIMO
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Credential | ADMIN
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Telephone | 516-708-1349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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