Healthcare Provider Details

I. General information

NPI: 1942465430
Provider Name (Legal Business Name): HEALTHCARE CLINIC AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 POTTS AVE
GREEN BAY WI
54304-4535
US

IV. Provider business mailing address

51 W. WALNUT ST.
STURGEON BAY WI
54235
US

V. Phone/Fax

Practice location:
  • Phone: 920-491-9079
  • Fax:
Mailing address:
  • Phone: 920-818-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN BESIADA-HANSEN
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 920-818-0424