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General NPI Number Information
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NPI Number | 1992560213
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Entity Type | Organization
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Legal Business Name | FOREFRONT DERMATOLOGY SC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 11211 120TH AVE STE A009B
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1703
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Country | US
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Telephone | 262-283-5333
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Fax | 262-912-0137
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETSY J WERNLI
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Credential | MD
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Telephone | 920-482-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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