Individual
MRS. KIZZIE MARIE DURGOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2000 DOMANIK DR, RACINE, WI 53404-2910
(262) 633-4800
Mailing address
2000 DOMANIK DR, RACINE, WI 53404-2910
(262) 633-4800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
16629730
WI
Other
Enumeration date
08/30/2012
Last updated
08/30/2012
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