Individual
CONNIE LEE WORM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2108 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3100
(920) 458-9401
(920) 458-8801
Mailing address
3532 N 21ST ST, SHEBOYGAN, WI 53083-2807
(920) 458-6556
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
86329-030
WI
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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