| NPI | 1164936019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA M KRIVORUCHKA Administration 608-213-4410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 07905) |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |