| NPI | 1629806336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY FRANKWICK Provider Certification Specialist 715-389-0632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2024-10-01 |