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General NPI Number Information
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NPI Number | 1790162899
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Entity Type | Organization
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Legal Business Name | ASSURE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 17187 TWIN PINES RD SUITE A
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City | LAKEWOOD
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State | WI
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Zip | 54138-9300
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Country | US
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Telephone | 715-850-0700
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Fax | 866-484-2182
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Provider Business Mailing Address
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Address Line | 17187 TWIN PINES RD SUITE A
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City | LAKEWOOD
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State | WI
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Zip | 54138-9300
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Country | US
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Telephone | 715-850-0700
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Fax | 866-484-2182
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Authorized Official
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Title or Position | FNP/OWNER
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Name | PEGGY S CHRISTIANSON
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Credential | FNP
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Telephone | 715-850-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4429-33
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License Number State | WI
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