Organization
WAUKESHA COUNTY
Active
Other names
Waukesha County (Public Health)
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M DEROSIER (CREDENTIALING SPECIALIST)
(262) 548-8431
Entity
Organization
Contact information
Practice address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 896-8430
(262) 896-8387
Mailing address
514 RIVERVIEW AVE, ATTN: FISCAL DEPARTMENT, WAUKESHA, WI 53188-3632
(262) 548-7212
(262) 970-6696
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
82059
WI
251K00000X
Public Health or Welfare Agency
000082059
WI
261QP2300X
Primary Care Clinic/Center
Primary
41861400
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000082059
MEDICARE LEGACY
WI
05
—
41861400
—
WI
Enumeration date
03/16/2007
Last updated
11/10/2025
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