1235728643 NPI number — WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.

Table of content: HOLLY MARTIN MILLET NP (NPI 1124658745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235728643 NPI number — WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235728643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W175N11120 STONEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53022-4799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-438-1772
Provider Business Mailing Address Fax Number:
262-293-9737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 W CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55041-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-438-1772
Provider Business Practice Location Address Fax Number:
262-345-5562
Provider Enumeration Date:
01/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RANGEL
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
INSURANCE COORDIANTOR
Authorized Official Telephone Number:
800-438-1772

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com