Provider Demographics
NPI:1154929909
Name:WATER CITY CARE MISSION, INC.
Entity type:Organization
Organization Name:WATER CITY CARE MISSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:920-234-6970
Mailing Address - Street 1:449 HIGH AVE.
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4708
Mailing Address - Country:US
Mailing Address - Phone:920-234-6970
Mailing Address - Fax:920-744-2488
Practice Address - Street 1:449 HIGH AVE.
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4708
Practice Address - Country:US
Practice Address - Phone:920-234-6970
Practice Address - Fax:920-744-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty