Healthcare Provider Details

I. General information

NPI: 1912264102
Provider Name (Legal Business Name): SLEEP WELLNESS INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N PORT WASHINGTON RD SUITE 210
MEQUON WI
53092-3485
US

IV. Provider business mailing address

2356 S 102ND ST SUITE A
WEST ALLIS WI
53227-2104
US

V. Phone/Fax

Practice location:
  • Phone: 414-336-3000
  • Fax: 414-336-1015
Mailing address:
  • Phone: 414-336-3000
  • Fax: 414-336-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENEE DEVINE
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 414-336-3000