| Sequoia Integrative Medical Services Llc | |
|
1351 Ontario Rd Green Bay WI 54311-8302 | |
| (920) 328-1220 | |
| Not Available |
| Full Name | Sequoia Integrative Medical Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1351 Ontario Rd, Green Bay, Wisconsin |
| Authorized Official Name and Position | Mary K Friess (PRESIDENT) |
| Authorized Official Contact | 9205791027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sequoia Integrative Medical Services Llc W2560 Birschbach Dr Mount Calvary WI 53057-9739 Ph: (920) 579-1027 | Sequoia Integrative Medical Services Llc 1351 Ontario Rd Green Bay WI 54311-8302 Ph: (920) 328-1220 |
| NPI Number | 1790312171 |
|---|---|
| Provider Enumeration Date | 03/25/2020 |
| Last Update Date | 09/22/2022 |
| Certification Date | 09/22/2022 |
| Medicare PECOS PAC ID | 8527480250 |
|---|---|
| Medicare Enrollment ID | O20200625000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790312171 | NPI | - | NPPES |
| 36015700 | Medicaid | WI |
| Provider Name | Mary K Friess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750479820 PECOS PAC ID: 5294732178 Enrollment ID: I20061107000429 |
| Provider Name | Lynne M Edebohls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154438760 PECOS PAC ID: 1456429349 Enrollment ID: I20081006000119 |
| Provider Name | Nicole M Welter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891047460 PECOS PAC ID: 4880847144 Enrollment ID: I20130117000156 |
| Provider Name | Christie S Henke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871835330 PECOS PAC ID: 3577700475 Enrollment ID: I20130514000201 |
| Provider Name | Lora Marie Moericke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801235858 PECOS PAC ID: 4880904515 Enrollment ID: I20151110001272 |
| Provider Name | Katie Gesch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063839447 PECOS PAC ID: 5294045225 Enrollment ID: I20171006000891 |
| Provider Name | Haley Hannah Decero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609478908 PECOS PAC ID: 7517359144 Enrollment ID: I20220111002763 |
| Provider Name | Teal Louise Calaway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144979519 PECOS PAC ID: 5890153894 Enrollment ID: I20230623001318 |
| Provider Name | Allison M Brusewitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891407540 PECOS PAC ID: 6608235080 Enrollment ID: I20230703000885 |
| Provider Name | Natalie Anne Banda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578269312 PECOS PAC ID: 2365894276 Enrollment ID: I20240116004020 |
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