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Organization
ROCHE A CRI CLINIC SC
Active
Organization
ROCHE A CRI CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARLENE WAHLEN (OFFICE MANAGER)
(609) 339-3326
Entity
Organization
Contact information
Practice address
302 W. LAKE ST., FRIENDSHIP, WI 53934
(608) 339-3326
(608) 339-6057
Mailing address
P.O. BOX 10, FRIENDSHIP, WI 53934-0010
(608) 339-3326
(608) 339-6057
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32742100
—
WI
05
—
43055000
—
WI
Enumeration date
07/10/2006
Last updated
07/21/2022
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