| NPI | 1356499784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMRA WHITE Medical Practice Administrator 715-463-7210 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 1034) |
| 363A00000X Physician Assistant (Licence: WI 1034) | |
| 363L00000X Nurse Practitioner (Licence: WI 1034) | |
| 367A00000X Advanced Practice Midwife (Licence: WI 1034) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2024-10-10 |