Organization
THEDACARE MEDICAL CENTER - WILD ROSE, INC
Active
Other names
WAUSHARA FAMILY PHYSICIANS
Organization subpart
No
Provider details
NPI number
Authorized official
JENIFER DANZEISEN RN (CLINIC MANAGER/ DIRECTOR OF NU)
(920) 622-5564
Entity
Organization
Contact information
Practice address
701 GROVE AVE, WILD ROSE, WI 54984-6901
(920) 622-6013
(920) 774-1026
Mailing address
PO BOX 314, WILD ROSE, WI 54984-0314
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
47322-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115407
PK
—
Enumeration date
03/08/2007
Last updated
07/31/2015
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