Provider Demographics
NPI:1285606178
Name:FOND DU LAC COUNTY
Entity type:Organization
Organization Name:FOND DU LAC COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOND DU LAC COUNTY HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:920-929-3085
Mailing Address - Street 1:160 S MACY ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4241
Mailing Address - Country:US
Mailing Address - Phone:920-929-3085
Mailing Address - Fax:920-929-3102
Practice Address - Street 1:160 S MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4241
Practice Address - Country:US
Practice Address - Phone:920-929-3085
Practice Address - Fax:920-929-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41850700Medicaid
WI44005100Medicaid
WI41850700Medicaid
WI44005100Medicaid