Provider Demographics
NPI:1760509996
Name:PEPIN COUNTY NURSING SERVICE
Entity Type:Organization
Organization Name:PEPIN COUNTY NURSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:715-672-5961
Mailing Address - Street 1:740 7TH AVE W
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-0039
Mailing Address - Country:US
Mailing Address - Phone:715-672-5961
Mailing Address - Fax:
Practice Address - Street 1:740 7TH AVE W
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1628
Practice Address - Country:US
Practice Address - Phone:715-672-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44003600Medicaid
WI41851700Medicaid
WI43080700Medicaid
WI000081075Medicare PIN