Provider Demographics
NPI:1366135253
Name:HONOR ON-SITE CLINICS
Entity type:Organization
Organization Name:HONOR ON-SITE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:715-558-3510
Mailing Address - Street 1:W179S6914 MUSKEGO DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9631
Mailing Address - Country:US
Mailing Address - Phone:715-558-3510
Mailing Address - Fax:
Practice Address - Street 1:605 W VETERANS WAY
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1116
Practice Address - Country:US
Practice Address - Phone:715-558-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HONOR ON-SITE CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty