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General NPI Number Information
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NPI Number | 1619341815
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Entity Type | Organization
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Legal Business Name | HEART FAILURE SURVIVAL CENTER OF AMERICA SC
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1281 MARINETTE AVE
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City | MARINETTE
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State | WI
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Zip | 54143-2018
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Country | US
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Telephone | 715-330-7090
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Fax | 715-732-0828
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Provider Business Mailing Address
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Address Line | 1281 MARINETTE AVE
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City | MARINETTE
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State | WI
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Zip | 54143-2018
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Country | US
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Telephone | 715-330-7090
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Fax | 715-732-0828
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | BRENDA M QUAAK
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Credential |
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Telephone | 715-330-7090
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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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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 47840-20
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License Number State | WI
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