Provider Demographics
NPI:1003336884
Name:3D BROWS AND WELLNESS LLC
Entity Type:Organization
Organization Name:3D BROWS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ULLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-277-6989
Mailing Address - Street 1:801 HOFFMAN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1462
Mailing Address - Country:US
Mailing Address - Phone:1920-277-6989
Mailing Address - Fax:
Practice Address - Street 1:801 HOFFMAN RD STE 106
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1462
Practice Address - Country:US
Practice Address - Phone:920-277-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICLIE-AHZQT3261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty