# THEDACARE MEDICAL CENTER - WILD ROSE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAUSHARA FAMILY PHYSICIANS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710018817
- **Authorized official:** JENIFER DANZEISEN RN (CLINIC MANAGER/ DIRECTOR OF NU)
- **Authorized official phone:** (920) 622-5564

## Contact information

- **Practice address:** 701 GROVE AVE, WILD ROSE, WI 54984-6901
- **Practice address phone:** (920) 622-6013
- **Practice address fax:** (920) 774-1026
- **Mailing address:** PO BOX 314, WILD ROSE, WI 54984-0314

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 47322-20 | WI | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 07/31/2015