Individual
PAUL ANTONISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
3957 GARRETT ST, DE PERE, WI 54115-1655
(920) 471-3729
Mailing address
3957 GARRETT ST, DE PERE, WI 54115-1655
(920) 471-3729
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
8973-33
WI
Other
Enumeration date
01/07/2019
Last updated
01/07/2019
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