Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2024-09-26
- Last updated
- 2024-09-26
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 509 N STATE ST
- City
- APPLETON WI
- Postal code
- 549114650
- Phone
- 920-316-6847
Organization contact
- Name
- YANNICK MUGEMANYI
- Title
- DIRECTOR
- Phone
- 9203166847
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.