Healthcare Provider Details

I. General information

NPI: 1538358007
Provider Name (Legal Business Name): NEW WOMEN'S HEALTHCARE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E REED AVE
MANITOWOC WI
54220-2123
US

IV. Provider business mailing address

716 N 9TH ST
MANITOWOC WI
54220-3926
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-9865
  • Fax:
Mailing address:
  • Phone: 920-683-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34329-020
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER GARVIN-CRESS
Title or Position: PRESIDENT
Credential:
Phone: 920-683-9865