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General NPI Number Information
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NPI Number | 1699697847
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Entity Type | Organization
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Legal Business Name | LEGACY OF FOUR SISTERA LLC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | N9351 S LAKE PARK RD UNIT 132
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City | APPLETON
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State | WI
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Zip | 54915-9488
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Country | US
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Telephone | 920-515-1534
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Fax |
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Provider Business Mailing Address
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Address Line | N9351 S LAKE PARK RD UNIT 132
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City | APPLETON
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State | WI
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Zip | 54915-9488
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Country | US
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Telephone | 920-515-1534
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DYNA INGABIRE
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Credential |
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Telephone | 920-515-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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