Provider Demographics
NPI:1972655975
Name:VILLAGE OF NORTH PRAIRIE
Entity Type:Organization
Organization Name:VILLAGE OF NORTH PRAIRIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHETTAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-542-9699
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:130 N HARRISON ST
Mailing Address - City:NORTH PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53153
Mailing Address - Country:US
Mailing Address - Phone:262-542-9699
Mailing Address - Fax:262-549-9177
Practice Address - Street 1:108 N OAKRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53153
Practice Address - Country:US
Practice Address - Phone:262-543-9699
Practice Address - Fax:262-549-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41351100Medicaid