WISCONSIN TELE-MED NETWORK NPI 1568821841

NPI Information

  • NPI: 1568821841
  • Provider Name: WISCONSIN TELE-MED NETWORK
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 52D2078114
  • Address: 6923 39TH AVE
    KENOSHA, WI
    ZIP 53142
  • Phone: (414) 416-3801

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NPI Details

WISCONSIN TELE-MED NETWORK is a family nurse practitioner in Kenosha, WI. WISCONSIN TELE-MED NETWORK NPI is 1568821841. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6923 39TH AVE
KENOSHA, WI
ZIP 53142-129
Phone: (414) 416-3801

The provider's authorized official is Jodi A Bova .
The authorized official title is Owner and has the following contact phone number (414) 416-3801.

The CLIA number assigned to this NPI record is 52D2078114 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/16/2016 and was last updated on 2/25/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerNo
2363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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