Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Oct 20, 2009
License(s)
4045-33 (WI), 4045-33 (WI), 4045-33 (WI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 735044 | Chicago, IL 60673-5044 | 800-326-2250 |
| LOCATION | N112W17975 MEQUON RD | Germantown, WI 53022-2425 | 262-532-7600 |
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