Provider Demographics
NPI:1871896308
Name:UNIVERSITY OF WISCONSIN STOUT
Entity type:Organization
Organization Name:UNIVERSITY OF WISCONSIN STOUT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SHS
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-232-2114
Mailing Address - Street 1:PO BOX 671205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1205
Mailing Address - Country:US
Mailing Address - Phone:866-890-6390
Mailing Address - Fax:469-735-4640
Practice Address - Street 1:103 1ST AVE W
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1876
Practice Address - Country:US
Practice Address - Phone:715-232-1314
Practice Address - Fax:715-232-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty