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NPI Code Detail

MEDICARE: TAKE CARE HEALTH WISCONSIN, S.C

MEDICARE: TAKE CARE HEALTH WISCONSIN, S.C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730241258
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAKE CARE HEALTH WISCONSIN, S.C
Provider Business Mailing Address
First Line : 1901 E VOORHEES ST
Second Line : MS 640
City : DANVILLE
State : IL
Zip : 61834-4509
Country : US
Telephone Number : 855-925-4733
Fax Number : 217-709-2345
Provider Business Practice Location Address
First Line : 6030 W OKLAHOMA AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53219-4133
Country : US
Telephone Number : 855-925-4733
Fax Number : 217-709-2345
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICIAL
Name : JENNIFER PHIPPS
Credential :
Telephone Number : 855-925-4733
Provider Enumeration Date : 12/14/2006
Last Update Date : 12/02/2015

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Directions to “TAKE CARE HEALTH WISCONSIN, S.C ” Practice Location

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