Healthcare Provider Details

I. General information

NPI: 1184901878
Provider Name (Legal Business Name): WHOLE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 FRANK LLOYD WRIGHT AVE SUITE 103
MIDDLETON WI
53562-1753
US

IV. Provider business mailing address

6720 FRANK LLOYD WRIGHT AVE SUITE 103
MIDDLETON WI
53562-1753
US

V. Phone/Fax

Practice location:
  • Phone: 608-821-0123
  • Fax: 608-821-0124
Mailing address:
  • Phone: 608-821-0123
  • Fax: 608-821-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number177540-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number84-049
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4484-033
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number148850-032
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMIE GIESEKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 608-821-0123