| NPI | 1932822004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN MICHAEL TACHICK Owner 920-660-6081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2023-10-30 |