| Lisas Advanced Practice Primary Care Staffing Corp | |
|
756 Pipestone St Benton Harbor MI 49022-4845 | |
| (269) 926-8535 | |
| Not Available |
| Full Name | Lisas Advanced Practice Primary Care Staffing Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 756 Pipestone St, Benton Harbor, Michigan |
| Authorized Official Name and Position | Lisa Janelle Wolske (CEO) |
| Authorized Official Contact | 2692521394 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisas Advanced Practice Primary Care Staffing Corp 756 Pipestone St Ste 3 Benton Harbor MI 49022-4845 Ph: (747) 100-6425 | Lisas Advanced Practice Primary Care Staffing Corp 756 Pipestone St Benton Harbor MI 49022-4845 Ph: (269) 926-8535 |
| NPI Number | 1134897812 |
|---|---|
| Provider Enumeration Date | 08/30/2021 |
| Last Update Date | 12/22/2021 |
| Medicare PECOS PAC ID | 6709283518 |
|---|---|
| Medicare Enrollment ID | O20210921003536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134897812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lisa J Wolske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538670344 PECOS PAC ID: 2668730904 Enrollment ID: I20171214002475 |
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