| NPI | 1407431562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY C EXTEROVICH Chief Operating Officer 608-963-0674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-15 |