Active NPI
Minuteclinic Primary Care Wisconsin LLC
- Family Nurse Practitioner
- Milwaukee, WI
National Provider Identifier
1104636281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- MINUTECLINIC PRIMARY CARE WISCONSIN LLC
- Practice address
- 1650 N Farwell Ave
Milwaukee, WI 53202-2331 - Phone
- (866) 389-2727
- NPI assigned
- Jan 10, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Deborah Pincince
- Title
- Administrator
- Phone
- (401) 770-3813
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
1650 N Farwell Ave
Milwaukee, WI 53202-2331
Mailing address
PO Box 772
Woonsocket, RI 02895-0784
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260625004479 | WI | Part B Supplier - Clinic/Group Practice | 3173096591 |
Receives reassigned benefits from 5 practitioners Practice locations: Fox Point, WI; Kenosha, WI; Milwaukee, WI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2341484 | Minuteclinic Primary Care Wisconsin, LLC #28723 | Certificate of waiver | Apr 1, 2028 |
National Provider Directory
National Provider DirectoryLocations
3710 57th Ave
Kenosha, WI 53144
Phone (262) 652-1474
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736467200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1774483200000",
"number": "1104636281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 772",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028950784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 N FARWELL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532022331",
"telephone_number": "866-389-2727"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MINUTECLINIC PRIMARY CARE WISCONSIN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2025-01-10",
"last_updated": "2026-03-26",
"certification_date": "2026-03-26",
"status": "A",
"authorized_official_last_name": "PINCINCE",
"authorized_official_first_name": "DEBORAH",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "401-770-3813"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.