Provider Demographics
NPI:1629739081
Name:PRECIOUS MOMENTS PNCC LLC
Entity Type:Organization
Organization Name:PRECIOUS MOMENTS PNCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AKYAA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-846-7315
Mailing Address - Street 1:8577 WEST CHEYENNE STREET, MILWAUKEE, WI, 53224, UNITED
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224
Mailing Address - Country:US
Mailing Address - Phone:702-846-7315
Mailing Address - Fax:
Practice Address - Street 1:8577 WEST CHEYENNE STREET, MILWAUKEE, WI, 53224, UNITED
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:702-846-7315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service