| NPI | 1497419956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LEE BERG-JOHNSON Adv Practice Nurse Practitioner 262-510-7412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2021-10-29 |