| NPI | 1578146171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIAN E INGRAM Owner/Operator 608-217-6108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 363LF0000X Nurse Practitioner, Family | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2022-02-16 |