# NEW MOMS OF GREEN BAY SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942349337
- **Authorized official:** SHANNON M TERRIEN (BUSINESS OFFICE)
- **Authorized official phone:** (920) 431-0200

## Contact information

- **Practice address:** 704 S WEBSTER AVE, STE 110, GREEN BAY, WI 54301-3528
- **Practice address phone:** (920) 431-0200
- **Mailing address:** 704 S WEBSTER AVE, STE 110, GREEN BAY, WI 54301-3528
- **Mailing address phone:** (920) 431-0200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 10/21/2009