Individual
MALES MAINVIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
333 E 2ND ST, RICHLAND CENTER, WI 53581-1914
(608) 647-6321
Mailing address
24959 MORRIS VALLEY RD, RICHLAND CENTER, WI 53581-6348
(608) 639-0413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
16165-33
WI
Other
Enumeration date
09/04/2024
Last updated
11/12/2024
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