Healthcare Provider Details

I. General information

NPI: 1649975210
Provider Name (Legal Business Name): ASPIRE PRENATAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 W BRADLEY RD STE 2036
MILWAUKEE WI
53223-3764
US

IV. Provider business mailing address

4680 W BRADLEY RD STE 203
BROWN DEER WI
53223-3764
US

V. Phone/Fax

Practice location:
  • Phone: 414-678-8994
  • Fax:
Mailing address:
  • Phone: 414-678-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARLA COOPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-678-8994