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General NPI Number Information
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NPI Number | 1033701115
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST CARE CLINIC, LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 108 GROVE ST
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City | EAGLE
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State | WI
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Zip | 53119-2249
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Country | US
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Telephone | 262-594-7012
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Fax | 313-556-1364
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Provider Business Mailing Address
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Address Line | 2125 PENHURST WAY
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City | WAUKESHA
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State | WI
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Zip | 53186-1224
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Country | US
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Telephone | 262-594-7012
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Fax | 313-556-1364
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA L OLSON
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Credential | APNP
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Telephone | 262-271-6280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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