MINUTECLINIC PRIMARY CARE WISCONSIN LLC
NPI 1104636281
Nurse Practitioner - Family in Milwaukee, WI

Q: What is Minuteclinic Primary Care Wisconsin LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since January 10, 2025CLIA 45D2299967 · Waiver

1650 N FARWELL AVE, MILWAUKEE, WI 53202(866) 389-2727 Get Directions Write a Review

NPPES record last updated: March 26, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 26, 2026, Jan 10, 2025 (2 updates tracked since 2025).

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About Minuteclinic Primary Care Wisconsin Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MINUTECLINIC PRIMARY CARE WISCONSIN LLC (NPI 1104636281) is a healthcare organization registered as a family in Milwaukee, Wisconsin and active in the NPI registry since January 2025. The organization holds a CLIA Waiver certificate valid through February 28, 2028 and lists Deborah Pincince, Administrator, as its authorized official.

NPPES Registry Identity

NPI1104636281

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameMINUTECLINIC PRIMARY CARE WISCONSIN LLC

Location Address1650 N FARWELL AVEMilwaukee, WI 53202-2331

Mailing AddressPo Box 772Woonsocket, RI 02895-0784

Phone(866) 389-2727

Organization SubpartNo

Authorized OfficialDeborah PincinceAdministrator · (401) 770-3813

Enumeration DateJanuary 10, 2025

Last NPPES UpdateMarch 26, 20262 updates tracked since enumeration

NPPES CertifiedMarch 26, 2026

✔ NPI 1104636281 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

1650 N FARWELL AVE, Milwaukee, WI 53202

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2299967

Minuteclinic Primary Care-Texas, PLLC · Baytown, TX

Active · expires Feb 28, 2028

CLIA Number45D2299967

Laboratory TypeHealth Care Clinic

Certificate Effective DateFebruary 28, 2026

Certificate Expiration DateFebruary 28, 2028

Laboratory DirectorLinda Moghalu

Laboratory Phone(866) 389-2727

Laboratory LocationMinuteclinic Primary Care-Texas, PLLC1514 N Alexander, Baytown, TX 77520

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MEGAN LO PHARMD

Pharmacist