| NPI | 1992159065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRIS MALDANADO Payor Activation Specialist 414-389-2233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 6922-33) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |