| NPI | 1609920743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA FOSSUM Owner 715-832-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 85943 030 NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 684 033 APNP) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2024-06-21 |