Provider Demographics
NPI:1063489292
Name:WELLNESS CENTER OF DOOR COUNTY INC
Entity Type:Organization
Organization Name:WELLNESS CENTER OF DOOR COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIGER-BRONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN APNP
Authorized Official - Phone:920-746-9444
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:312 N 5TH AVE
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-746-9444
Mailing Address - Fax:920-746-9466
Practice Address - Street 1:312 N 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235
Practice Address - Country:US
Practice Address - Phone:920-746-9444
Practice Address - Fax:920-746-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42011800Medicaid
WI42011800Medicaid