| NPI | 1720595366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY A CONWAY Sole Member 715-439-3084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2020-10-02 |