Organization
NEW MOMS OF GREEN BAY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON M TERRIEN (BUSINESS OFFICE)
(920) 431-0200
Entity
Organization
Contact information
Practice address
704 S WEBSTER AVE, STE 110, GREEN BAY, WI 54301-3528
(920) 431-0200
Mailing address
704 S WEBSTER AVE, STE 110, GREEN BAY, WI 54301-3528
(920) 431-0200
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
02/05/2007
Last updated
10/21/2009
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