| NPI | 1992442156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL DETRICK Cep 920-430-1350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0050X Clinic/Center, Family Planning, Non-Surgical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-05-18 |