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General NPI Number Information
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NPI Number | 1992079891
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Entity Type | Organization
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Legal Business Name | SCHOOL SISTERS OF NOTRE DAME CENTRAL PACIFIC PROVINCE, INC.
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 13105 WATERTOWN PLANK RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2213
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Country | US
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Telephone | 262-782-9850
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Fax | 262-784-9788
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Provider Business Mailing Address
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Address Line | 13105 WATERTOWN PLANK RD
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City | ELM GROVE
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State | WI
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Zip | 53122-2213
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Country | US
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Telephone | 262-782-9850
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Fax | 262-784-9788
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Authorized Official
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Title or Position | CFO
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Name | DANA RUSSART
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Credential |
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Telephone | 262-782-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State | WI
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