| NPI | 1669296364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL BLOHOWIAK Owner 920-324-9899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2024-11-21 |