Individual
MARK J. MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
139193
WI
Other
Enumeration date
12/16/2011
Last updated
12/16/2011
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