| NPI | 1275767485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRAN BOLDEN Credentialing Coordinator 414-372-8080 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: WI 6282-800) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2011-11-30 |