Provider Demographics
NPI:1528447257
Name:TRINITY HEALTH-CARE OF WI LLC
Entity type:Organization
Organization Name:TRINITY HEALTH-CARE OF WI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINDIGOGUZULU
Authorized Official - Suffix:
Authorized Official - Credentials:RN-MSN/MBA-FNPBC
Authorized Official - Phone:608-298-8441
Mailing Address - Street 1:PO BOX 5065
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-0065
Mailing Address - Country:US
Mailing Address - Phone:608-298-8441
Mailing Address - Fax:
Practice Address - Street 1:1574 W BROADWAY
Practice Address - Street 2:SUITE # 103
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1824
Practice Address - Country:US
Practice Address - Phone:608-298-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5674-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty