Healthcare Provider Details

I. General information

NPI: 1801083548
Provider Name (Legal Business Name): WOMENS HEALTH CARE ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N RAPIDS RD
MANITOWOC WI
54220-3408
US

IV. Provider business mailing address

304 N RAPIDS RD
MANITOWOC WI
54220-3408
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-0321
  • Fax: 920-683-9078
Mailing address:
  • Phone: 920-683-0321
  • Fax: 920-683-9078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29141-020
License Number StateWI

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ROBERT NOLAN HETZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 920-683-0321