Individual
KELLY VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, NP, APNP
Contact information
Practice address
13111 N PORT WASHINGTON RD, MEQUON, WI 53097-2416
(414) 243-7300
Mailing address
13111 N PORT WASHINGTON RD, MEQUON, WI 53097-2416
(262) 243-7300
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
148827-032
WI
363L00000X
Nurse Practitioner
Primary
3589-033
WI
Other
Enumeration date
10/06/2008
Last updated
03/22/2012
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