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Individual
KELLY SUE MCMAHON
Active
Individual
KELLY SUE MCMAHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7461-33
WI
363LW0102X
Women's Health Nurse Practitioner
087220
IA
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
087220
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0433433
—
IA
Enumeration date
01/23/2006
Last updated
10/28/2019
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