| NPI | 1679460729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT D MINGILINO Owner / Nurse Practitioner 262-818-6615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-06-24 |