| NPI | 1316581440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE M SIDDONS Co Founder 920-217-9035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-12-22 |