Provider Demographics
NPI:1184840423
Name:MACDOUGAL, EDITH C (RN)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:C
Last Name:MACDOUGAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:EDITH
Other - Middle Name:C
Other - Last Name:SIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1407 ST. ANDREW ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4002
Mailing Address - Country:US
Mailing Address - Phone:608-785-5939
Mailing Address - Fax:608-785-6315
Practice Address - Street 1:1407 ST. ANDREW ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4002
Practice Address - Country:US
Practice Address - Phone:608-785-5939
Practice Address - Fax:608-785-6315
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70380030163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management