Healthcare Provider Details

I. General information

NPI: 1164276432
Provider Name (Legal Business Name): WISCONSIN OUTREACH FOR MOTHERS AND BABIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 N 2ND ST
MILWAUKEE WI
53212-1509
US

IV. Provider business mailing address

3630 N 2ND ST
MILWAUKEE WI
53212-1509
US

V. Phone/Fax

Practice location:
  • Phone: 414-445-0245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA BRUMFIELD
Title or Position: DIRECTOR
Credential:
Phone: 414-442-5405