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General NPI Number Information
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NPI Number | 1164227401
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Entity Type | Organization
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Legal Business Name | MISSION HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4821 N 64TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-4020
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Country | US
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Telephone | 262-599-4468
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Fax |
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Provider Business Mailing Address
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Address Line | 4821 N 64TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53218-4020
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Country | US
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Telephone | 262-599-4468
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINALD CEPHUS
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Credential |
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Telephone | 262-450-5045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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