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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
SACHA SIMMONS (EXECUTIVE DIRECTOR)
(414) 436-4922
Entity
Organization

Contact information

Practice address
9010 W NORTH AVE APT 5, MILWAUKEE, WI 53226-2660
(414) 436-4922
Mailing address
N78W14573 APPLETON AVE # 179, MENOMONEE FALLS, WI 53051-4382
(414) 436-4922

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary

Other

Enumeration date
07/04/2024
Last updated
07/04/2024
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