Provider Demographics
NPI:1669142949
Name:WISCONSIN RESOURCE CENTER
Entity type:Organization
Organization Name:WISCONSIN RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APNP
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZODROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-426-4310
Mailing Address - Street 1:1470 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7441
Mailing Address - Country:US
Mailing Address - Phone:920-379-1250
Mailing Address - Fax:
Practice Address - Street 1:1505 NORTH DRIVE
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0016
Practice Address - Country:US
Practice Address - Phone:920-426-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty