Provider Demographics
NPI:1417767740
Name:ONEIDA NATION
Entity type:Organization
Organization Name:ONEIDA NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DANFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:920-869-2711
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155-0365
Mailing Address - Country:US
Mailing Address - Phone:920-869-2711
Mailing Address - Fax:920-869-1785
Practice Address - Street 1:2901 S OVERLAND RD
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-8959
Practice Address - Country:US
Practice Address - Phone:920-869-2797
Practice Address - Fax:920-869-6790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONEIDA NATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy