Provider Demographics
NPI:1790955664
Name:UNIVERSITY OF WISCONSIN-PLATTEVILLE
Entity Type:Organization
Organization Name:UNIVERSITY OF WISCONSIN-PLATTEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DREESSENS
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:608-342-1891
Mailing Address - Street 1:1 UNIVERSITY PLAZA
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3099
Mailing Address - Country:US
Mailing Address - Phone:608-342-1891
Mailing Address - Fax:608-342-1028
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3001
Practice Address - Country:US
Practice Address - Phone:608-342-1891
Practice Address - Fax:608-342-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42012600Medicaid