Individual
MARY JANE DE JESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3727 W WISCONSIN AVE, MILWAUKEE, WI 53208-3182
(414) 291-2626
Mailing address
3727 W WISCONSIN AVE, MILWAUKEE, WI 53208-3182
(414) 291-2626
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
199574-30
WI
363LF0000X
Family Nurse Practitioner
Primary
10316-33
WI
Other
Enumeration date
08/20/2020
Last updated
03/29/2021
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