| Renewed Brain Health Llc | |
|
122 High St Mineral Point WI 53565-1287 | |
| (608) 778-6833 | |
| (608) 305-8956 |
| Full Name | Renewed Brain Health Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 122 High St, Mineral Point, Wisconsin |
| Authorized Official Name and Position | Cecelia Greenwood (OWNER) |
| Authorized Official Contact | 6087786833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Brain Health Llc 122 High St Mineral Point WI 53565-1287 Ph: (608) 778-6833 | Renewed Brain Health Llc 122 High St Mineral Point WI 53565-1287 Ph: (608) 778-6833 |
| NPI Number | 1790515765 |
|---|---|
| Provider Enumeration Date | 08/05/2024 |
| Last Update Date | 08/05/2024 |
| Certification Date | 08/05/2024 |
| Medicare PECOS PAC ID | 0446790281 |
|---|---|
| Medicare Enrollment ID | O20240909000829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790515765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Andrea Ann Kaiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649905381 PECOS PAC ID: 1759764111 Enrollment ID: I20220817002149 |
| Provider Name | Cecelia Ann Greenwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689262628 PECOS PAC ID: 2264808310 Enrollment ID: I20221014002172 |