Provider Demographics
NPI:1609920743
Name:WILLOW CREEK WOMENS CLINIC SC
Entity Type:Organization
Organization Name:WILLOW CREEK WOMENS CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POIRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN FNPC APNP
Authorized Official - Phone:715-832-9292
Mailing Address - Street 1:1470 RIVERS EDGE TRL STE 3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2755
Mailing Address - Country:US
Mailing Address - Phone:715-832-9292
Mailing Address - Fax:715-832-4172
Practice Address - Street 1:1470 RIVERS EDGE TRL STE 3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2755
Practice Address - Country:US
Practice Address - Phone:715-832-9292
Practice Address - Fax:715-832-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI684 033 APNP363L00000X
WI85943 030 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43898700Medicaid
S72246Medicare UPIN
WI00002005Medicare ID - Type Unspecified