Individual
MS. BONNIE KAY MALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
118 E 9TH ST, FOND DU LAC, WI 54935
(920) 948-6922
Mailing address
118 E 9TH ST, FOND DU LAC, WI 54935
(920) 948-6922
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
167227-30
WI
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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