Organization
STATE MEDICAID
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JANICE REMUS RN (CASE MANAGER)
(608) 848-7745
Entity
Organization
Contact information
Practice address
824 LOTHE ST, SUN PRAIRIE, WI 53590-2710
(608) 334-0900
Mailing address
824 LOTHE ST, SUN PRAIRIE, WI 53590-2710
(608) 334-0900
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
WI
Other
Enumeration date
09/07/2006
Last updated
08/22/2020
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