Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2020-04-26
- Last updated
- 2026-02-23
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 712 SUMMIT AVE
- City
- OCONOMOWOC WI
- Postal code
- 530663827
- Phone
- 262-262-2006
Organization contact
- Name
- AMANDA DONATH
- Title
- Owner
- Phone
- 2622262006
Medicare
- PECOS
- A PECOS enrollment row matches 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.