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General NPI Number Information
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NPI Number | 1972793818
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Entity Type | Organization
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Legal Business Name | NORTHEAST WISCONSIN TECHNICAL COLLEGE
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 2740 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4966
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Country | US
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Telephone | 920-498-5543
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 W MASON ST P.O.BOX 19042
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City | GREEN BAY
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State | WI
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Zip | 54303-4966
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JAMES BLUMREICH
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Credential |
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Telephone | 920-498-5701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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