| NPI | 1831698430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY HALE Owner 262-225-1014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 2011006054) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 6190-33) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2018-02-08 |