Healthcare Provider Details

I. General information

NPI: 1104636281
Provider Name (Legal Business Name): MINUTECLINIC PRIMARY CARE WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 N FARWELL AVE
MILWAUKEE WI
53202-2331
US

IV. Provider business mailing address

PO BOX 772
WOONSOCKET RI
02895-0784
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH PINCINCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-770-3813