| NPI | 1194216416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATJANA STEVANOVIC Adult Nurse Practioner 262-923-3777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: WI 52D1037628) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2023-11-20 |