| NPI | 1437789450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE HETTMANN Provider Credentialing Coordinator 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207P00000X Emergency Medicine | |
| 207T00000X Neurological Surgery | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2022-09-01 |