| NPI | 1912078718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY FOGELTANZ Practice Manager 715-552-7303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WI 37801-020) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-05-21 |