Provider Demographics
NPI:1003324617
Name:VILLAGE PRIMARY CARE PROVIDERS LLC
Entity Type:Organization
Organization Name:VILLAGE PRIMARY CARE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:262-352-5604
Mailing Address - Street 1:1111 DELAFIELD ST STE 327
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3407
Mailing Address - Country:US
Mailing Address - Phone:414-852-0511
Mailing Address - Fax:
Practice Address - Street 1:1111 DELAFIELD ST STE 327
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3407
Practice Address - Country:US
Practice Address - Phone:262-875-4892
Practice Address - Fax:866-817-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992040257Medicaid
WI100095913Medicaid