Provider Demographics
NPI:1811167729
Name:UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Entity type:Organization
Organization Name:UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, C, MSN
Authorized Official - Phone:715-836-4311
Mailing Address - Street 1:630 HILLTOP CIR
Mailing Address - Street 2:CREST WELLNESS CENTER
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6196
Mailing Address - Country:US
Mailing Address - Phone:715-836-4311
Mailing Address - Fax:715-836-5979
Practice Address - Street 1:630 HILLTOP CIR
Practice Address - Street 2:CREST WELLNESS CENTER
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6196
Practice Address - Country:US
Practice Address - Phone:715-836-4311
Practice Address - Fax:715-836-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42012200261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center