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General NPI Number Information
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NPI Number | 1144894494
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Entity Type | Organization
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Legal Business Name | ANDROMEDA WELLNESS CENTER INC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 582 FARGO TRL
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City | MIDDLETON
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State | WI
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Zip | 53562-5667
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Country | US
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Telephone | 608-216-4374
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Fax | 608-716-3148
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Provider Business Mailing Address
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Address Line | 6907 UNIVERSITY AVE STE 304
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City | MIDDLETON
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State | WI
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Zip | 53562-2767
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Country | US
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Telephone | 608-216-4374
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Fax | 608-716-3148
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Authorized Official
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Title or Position | OWNER
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Name | NURA MISTY BUDZINSKI
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Credential |
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Telephone | 608-216-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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