Provider Demographics
NPI:1740094192
Name:CARROLL UNIVERSITY INC.
Entity type:Organization
Organization Name:CARROLL UNIVERSITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, STUDENT HEALTH CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLATA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:262-524-7233
Mailing Address - Street 1:100 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3103
Mailing Address - Country:US
Mailing Address - Phone:262-524-7233
Mailing Address - Fax:262-650-4897
Practice Address - Street 1:100 N EAST AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3103
Practice Address - Country:US
Practice Address - Phone:262-524-7233
Practice Address - Fax:262-650-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932326204Medicaid
WI1659488187Medicaid