1. Home
  2. Directory
  3. Wisconsin
  4. Milwaukee
  5. Nurse Practitioner
  6. NPI Profile

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

Active since January 10, 2025CLIA Certified · 94 labs
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: October 25, 2026.

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

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 94 active CLIA laboratory certificates 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
Open in Google Maps ↗

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Minuteclinic Primary Care Wisconsin Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Minuteclinic Primary Care Wisconsin LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Mary Clementi, FNP-C
Nurse Practitioner
NPI 1346896594
5800 W. LAYTON AVE
Greenfield, WI 53220
(262) 532-3067
✔ PECOS✔ Accepts Medicare7.9 mi
Mercy Mahaga, APNP, RN
Nurse Practitioner
NPI 1760882229
514 RIVERVIEW AVE
Waukesha, WI 53188
(262) 548-7666
✔ PECOS17 mi
Ebonie Gray, RN, APNP, FNP-BC
Nurse Practitioner
NPI 1982840757
3710 57TH AVE
Kenosha, WI 53144
(262) 652-1474
✔ PECOS✔ Accepts Medicare31 mi
Ann Leeder, FNP-BC
Nurse Practitioner
NPI 1790151355
3710 57TH AVE
Kenosha, WI 53144
(414) 526-9024
✔ PECOS✔ Accepts Medicare31 mi
Alison Shelton, FNP-BC
Nurse Practitioner
NPI 1114492386
3710 57TH AVE
Kenosha, WI 53144
(866) 389-2727
✔ PECOS✔ Accepts Medicare31 mi
Jennifer Nabong, APN, FNP
Nurse Practitioner
NPI 1780912204
11200 W LINCOLN HWY
Mokena, IL 60448
(815) 464-2171
✔ PECOS107 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 126

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 10D1059213

Minuteclinic, LLC · Plantation, FL
Active · expires Sep 25, 2028
CLIA Number10D1059213
Laboratory TypeLimited Service Hcc
Certificate Effective DateSeptember 26, 2026
Certificate Expiration DateSeptember 25, 2028
Laboratory DirectorAlina Pastoriza Garcia
Laboratory Phone(866) 389-2727
Laboratory LocationMinuteclinic, LLC10241 W Broward Blvd, Plantation, FL 33324
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1059216

Minuteclinic LLC · Miramar, FL
Active · expires Sep 25, 2028
CLIA Number10D1059216
Laboratory TypeLimited Service Healthcar
Certificate Effective DateSeptember 26, 2026
Certificate Expiration DateSeptember 25, 2028
Laboratory DirectorAlina Pastoriza Garcia
Laboratory Phone(866) 389-2727
Laboratory LocationMinuteclinic LLC12401 Miramar Parkway, Miramar, FL 33027
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1059219

Minuteclinic LLC · Cooper City, FL
Active · expires Sep 25, 2028
CLIA Number10D1059219
Laboratory TypeLimited Service Hhc
Certificate Effective DateSeptember 26, 2026
Certificate Expiration DateSeptember 25, 2028
Laboratory DirectorAlina Pastoriza Garcia
Laboratory Phone(866) 389-2727
Laboratory LocationMinuteclinic LLC4701 S Flamingo Rd, Cooper City, FL 33330
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1059225

Minuteclinic LLC · Boca Raton, FL
Active · expires Sep 25, 2028
CLIA Number10D1059225
Laboratory TypeOther
Certificate Effective DateSeptember 26, 2026
Certificate Expiration DateSeptember 25, 2028
Laboratory DirectorLorraine Hendricksen
Laboratory Phone(866) 389-2727
Laboratory LocationMinuteclinic LLC520 South Federal Highway, Boca Raton, FL 33432
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1059234

Minuteclinic LLC · Lake Worth, FL
Active · expires Sep 25, 2028
CLIA Number10D1059234
Laboratory TypeLimited Services Healthca
Certificate Effective DateSeptember 26, 2026
Certificate Expiration DateSeptember 25, 2028
Laboratory DirectorLorraine Hendricksen
Laboratory Phone(866) 389-2727
Laboratory LocationMinuteclinic LLC8954 Lantana Rd, Lake Worth, FL 33467
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1059253

Minuteclinic, LLC · Miami, FL
Active · expires Sep 25, 2028
CLIA Number10D1059253
Laboratory TypeLimited Service Hhc
Certificate Effective DateSeptember 26, 2026
Certificate Expiration DateSeptember 25, 2028
Laboratory DirectorAlina Pastoriza Garcia
Laboratory Phone(866) 389-2727
Laboratory LocationMinuteclinic, LLC13199 SW 112th St, Miami, FL 33186
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Minuteclinic Primary Care Wisconsin LLC's NPI number?

The NPI number for Minuteclinic Primary Care Wisconsin LLC is 1104636281. It was assigned to this organization in the NPPES registry on January 10, 2025.

Where is Minuteclinic Primary Care Wisconsin LLC located?

Minuteclinic Primary Care Wisconsin LLC is located at 1650 N Farwell Ave, Milwaukee, WI 53202. The listed phone number is (866) 389-2727.

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.

Is Minuteclinic Primary Care Wisconsin LLC enrolled in Medicare?

Yes. Minuteclinic Primary Care Wisconsin LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Minuteclinic Primary Care Wisconsin LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Minuteclinic Primary Care Wisconsin LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Minuteclinic Primary Care Wisconsin LLC hold CLIA laboratory certificates?

Yes. 94 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Minuteclinic Primary Care Wisconsin LLC was last updated on March 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.