Organization
FENNIMORE HEALING ARTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA LEASE APNP, PMHNP-BC (NURSE PRACTIONER)
(608) 572-3494
Entity
Organization
Contact information
Practice address
770 LINCOLN AVE, SUITE 2, FENNIMORE, WI 53809-1562
(608) 572-3494
(608) 822-3812
Mailing address
770 LINCOLN AVE, SUITE 2, FENNIMORE, WI 53809-1562
(608) 572-3494
(608) 822-3812
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4062-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215243852
—
WI
01
—
849190006
MEDICARE PTAN
WI
Enumeration date
11/18/2013
Last updated
03/31/2016
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