Healthcare Provider Details

I. General information

NPI: 1740938638
Provider Name (Legal Business Name): OUR FUTURE PRENATAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 57TH ST STE G
KENOSHA WI
53140-4062
US

IV. Provider business mailing address

4721 N 74TH ST
MILWAUKEE WI
53218-4716
US

V. Phone/Fax

Practice location:
  • Phone: 414-326-6220
  • Fax:
Mailing address:
  • Phone: 414-326-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA SELLERS
Title or Position: OWNER
Credential:
Phone: 414-326-6220