Healthcare Provider Details

I. General information

NPI: 1164476214
Provider Name (Legal Business Name): ADVANCED CARE FOR WOMEN, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

IV. Provider business mailing address

2411 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

V. Phone/Fax

Practice location:
  • Phone: 920-888-2828
  • Fax: 888-876-4773
Mailing address:
  • Phone: 920-888-2828
  • Fax: 888-876-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HERBERT S COUSSONS
Title or Position: OWNER
Credential:
Phone: 920-888-2828