Provider Demographics
NPI:1225287691
Name:ST NORBERT COLLEGE
Entity Type:Organization
Organization Name:ST NORBERT COLLEGE
Other - Org Name:DEPARTMENT OF HEALTH AND WELLNESS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC PROVIDER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROOBANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-445-7222
Mailing Address - Street 1:100 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2002
Mailing Address - Country:US
Mailing Address - Phone:920-403-3266
Mailing Address - Fax:
Practice Address - Street 1:100 GRANT ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2002
Practice Address - Country:US
Practice Address - Phone:920-403-3266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health