| NPI | 1720492309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN MATAVKA Executive Vice President 414-376-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |