| NPI | 1053718890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA A CARMODY Clinic Director 920-784-2646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WI 4151-125) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 1826-33) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2015-06-17 |