Organization
WISCONSIN TELE-MED NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI A BOVA (OWNER)
(414) 416-3801
Entity
Organization
Contact information
Practice address
6923 39TH AVE, KENOSHA, WI 53142-7129
(414) 416-3801
Mailing address
W146S6974 CATALINA DR, MUSKEGO, WI 53150-3116
(414) 416-3801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/16/2016
Last updated
02/25/2016
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