| NPI | 1194158915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN MATAVKA Executive Vice President 262-641-9050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 2174) |
| 207Q00000X Family Medicine | |
| 208D00000X General Practice | |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-09-11 |