Teen Moms Wellness PNCC, LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

TEEN MOMS WELLNESS PNCC, LLC

Practice address

9713 W Lisbon Ave
Milwaukee, WI 53222-2533

Phone

(414) 630-4463

NPI assigned

Jan 26, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dominique Hatchett

Title

Ceo

Phone

(262) 218-1249

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1922751353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9713 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532222533",
            "telephone_number": "262-218-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9713 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532222533",
            "telephone_number": "414-630-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEEN MOMS WELLNESS PNCC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "HATCHETT",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "262-218-1249"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerome Michael Teclaw, DDS
• Michele A Teclaw
• Daniom Tecle, MD
• Tee'S Direct Care LLC
• Megan Beth Teed, DNP, FNP-BC, APNP
• Mary Teetzen
• Elizabeth Teferra
• Brittany Tefft
• Courtney Teichert
• Katie M Teichmiller, APNP

• Case Management Agency in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Case Management Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.