Provider Demographics
NPI:1497419956
Name:INTEGRATIVE MEDICAL SOLUTIONS OF LAKE MILLS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL SOLUTIONS OF LAKE MILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADV PRACTICE NURSE PRACTITIONER
Authorized Official - Prefix:PROF
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BERG-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, APNP
Authorized Official - Phone:262-510-7412
Mailing Address - Street 1:125 E PINE ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1103
Mailing Address - Country:US
Mailing Address - Phone:920-648-5271
Mailing Address - Fax:920-648-4365
Practice Address - Street 1:125 E PINE ST STE C
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1103
Practice Address - Country:US
Practice Address - Phone:920-648-5271
Practice Address - Fax:920-648-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty