| Lifesource Of North Carolina | |
|
3540 S 43rd St Milwaukee WI 53220-1502 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 3540 S 43rd St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT/OWNER) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 3540 S 43rd St Milwaukee WI 53220-1502 Ph: (910) 742-9243 |
| NPI Number | 1871135723 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20210907000784 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871135723 | NPI | - | NPPES |
| Provider Name | Heather N Mikkelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588190607 PECOS PAC ID: 5597199844 Enrollment ID: I20191219002807 |
| Provider Name | Aizhan Tyndybekova Repchak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992070379 PECOS PAC ID: 0446687867 Enrollment ID: I20210907000871 |
| Provider Name | Courtney L Steuer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972099760 PECOS PAC ID: 7315343993 Enrollment ID: I20210907002506 |
| Provider Name | Brittany Cook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649820622 PECOS PAC ID: 2860899846 Enrollment ID: I20210917000056 |
| Provider Name | Heather Mcfarland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508258583 PECOS PAC ID: 2668773243 Enrollment ID: I20210920002871 |
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