| NPI | 1508248766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN KING Sole Mbr 414-803-4352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9322553) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |