| NPI | 1720317092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL J VAN PAY Coordinator 920-845-5085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: WI 0012647) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2009-12-16 |