| Nova Integrated Care Llc | |
|
302 W Pine St Ste 2 Eagle River WI 54521-9349 | |
| (715) 891-0088 | |
| Not Available |
| Full Name | Nova Integrated Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 302 W Pine St Ste 2, Eagle River, Wisconsin |
| Authorized Official Name and Position | Jill Brunstad (OWNER/PHYSICIAN ASSISTANT) |
| Authorized Official Contact | 7158910088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nova Integrated Care Llc 302 W Pine St Ste 2 Eagle River WI 54521-9349 Ph: (715) 891-0088 | Nova Integrated Care Llc 302 W Pine St Ste 2 Eagle River WI 54521-9349 Ph: (715) 891-0088 |
| NPI Number | 1679355358 |
|---|---|
| Provider Enumeration Date | 10/18/2023 |
| Last Update Date | 10/18/2023 |
| Medicare PECOS PAC ID | 2860837291 |
|---|---|
| Medicare Enrollment ID | O20240226001791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679355358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Adrienne D Laverdure |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639119225 PECOS PAC ID: 1850280876 Enrollment ID: I20051025000720 |
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