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General NPI Number Information
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NPI Number | 1366135253
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Entity Type | Organization
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Legal Business Name | HONOR ON-SITE CLINICS
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 605 W VETERANS WAY
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City | MUKWONAGO
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State | WI
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Zip | 53149-1116
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Country | US
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Telephone | 715-558-3510
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Fax |
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Provider Business Mailing Address
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Address Line | W179S6914 MUSKEGO DR
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City | MUSKEGO
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State | WI
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Zip | 53150-9631
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Country | US
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Telephone | 715-558-3510
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICIAN ASSISTANT
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Name | JENNIFER FICK
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Credential | PA-C
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Telephone | 715-558-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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