Healthcare Provider Details

I. General information

NPI: 1760755094
Provider Name (Legal Business Name): WHOLE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

6720 FRANK LLOYD WRIGHT AVE STE 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 TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL

VIII. Authorized Official

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