Provider Demographics
NPI:1578323192
Name:DEGRUSH, CHADD FRANCIS (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHADD
Middle Name:FRANCIS
Last Name:DEGRUSH
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-7921
Mailing Address - Country:US
Mailing Address - Phone:608-345-0641
Mailing Address - Fax:
Practice Address - Street 1:803 CLARA AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-7921
Practice Address - Country:US
Practice Address - Phone:608-345-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15179-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty