THEDACARE, INC (NPI# 1063569002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063569002 |
| Entity Type | Organization |
| Organization Name | THEDACARE, INC |
| Other Organization Name | THEDACARE AT WORK |
| Practice Address |
2809 N. Park Drive Lane Appleton WI 54911 |
| Practice Telephone | 9203804999 |
| Practice Fax Number | 9203804961 |
| Mailing Telephone | 9203804999 |
| Mailing Fax Number | 9203804961 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2010-01-19 |
| Authorized Official Name | GINA AUGUSTINE (MANAGER) |
| Authorized Official Telephone | 9203804967 |
| Is Organization Subpart | Y |
| Parent Organization Name | THEDACARE, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| Y | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| ThedaCare at Work | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | THEDACARE, INC. | 122 E College Ave Ste 2a, Appleton, WI 54911-5741 |
| Street Address |
2809 N. PARK DRIVE LANE |
| City | APPLETON |
| State | WI |
| Zip Code | 54911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396802823 | Ellen Pitsch | Nurse Practitioner | 2809 N. Park Drive Lane, Appleton, WI 54911 | 2007-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545633 | Brotherly Love, LLC | Day Training, Developmentally Disabled Services | 1513 E Frances St, Appleton, WI 54911 | 2019-12-12 |
| 1952952129 | Eagle Point Senior Living Inc | Assisted Living Facility | 995 East John Street, Appleton, WI 54911 | 2019-09-27 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1174080063 | Shayla Russell | Counselor | Outagamie County Health and Human Services, 320 S. Walnut St., Appleton, WI 54911 | 2019-02-27 |
| 1871086645 | Megan Kilsdonk | Health Educator | 1604 N Meade St, Appleton, WI 54911 | 2018-06-07 |
| 1871085480 | Tanya Lynn Vickery | Social Worker | 410 S. Elm St., Appleton, WI 54911 | 2018-05-31 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| 1093211211 | Bonnie Anne Korytkowski | Student in an Organized Health Care Education/Training Program | 229 S. Morrison Street, Appleton, WI 54911 | 2018-04-05 |
| 1639673940 | Brett Follett | Psychologist | 401 S. Elm St., Appleton, WI 54911 | 2018-03-21 |
| 1700202892 | Brian Withrow | Counselor | 607 West 7th St., Appleton, WI 54911 | 2014-03-13 |
| Find all providers in zip 54911 | ||||
| Taxonomy Code | 363LX0106X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Occupational Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659858181 | Tanya Lalk | Nurse Practitioner | 201 N Mayfair Rd Ste 550, Wauwatosa, WI 53226-4216 | 2018-07-27 |
| 1215177175 | Diane Elizabeth Daugharty | Nurse Practitioner | 2100 Winchester Rd, Neenah, WI 54956-9317 | 2009-03-04 |
| 1336783042 | Lisa Jo Liedke | Nurse Practitioner | 420 E Division St, Fond Du Lac, WI 54935-4560 | 2019-11-05 |
| 1528449568 | Jenna Lease | Nurse Practitioner | W180n8000 Town Hall Rd, Menomonee Falls, WI 53051-4002 | 2015-06-16 |
| 1164850780 | Jennifer Schaffer | Nurse Practitioner | 180 Gateway Dr, Waupun, WI 53963-2276 | 2013-10-16 |
| 1497952410 | Yvonne T Nelson | Nurse Practitioner | 3021 Voyager Dr, Green Bay, WI 54311-8303 | 2007-07-02 |
| 1922002435 | Joni L Nalli | Nurse Practitioner | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-06-13 |
Please comment or provide details below to improve the information on THEDACARE, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.