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General NPI Number Information
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NPI Number | 1528633849
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Entity Type | Organization
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Legal Business Name | BLUE SKY MENTAL HEALTH, SC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 6666 ODANA RD # 323
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City | MADISON
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State | WI
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Zip | 53719-1012
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Country | US
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Telephone | 608-556-3813
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Fax |
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Provider Business Mailing Address
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Address Line | 6666 ODANA RD # 323
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City | MADISON
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State | WI
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Zip | 53719-1012
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Country | US
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Telephone | 608-556-3813
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. TERI WHITE
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Credential | DNP
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Telephone | 608-556-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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