=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275286858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2022
-----------------------------------------------------
Last Update Date | 02/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6914 W APPLETON AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-290-7596
-----------------------------------------------------
Fax | 414-908-9571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5521 W CENTER ST UNIT 100934
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53210-7530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-533-0133
-----------------------------------------------------
Fax | 856-249-9048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JENNIFER NELSON
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 414-533-0133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------