Individual
MARY B PAULONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
6915 45TH AVE, KENOSHA, WI 53142-3832
(262) 658-1840
Mailing address
6915 45TH AVE, KENOSHA, WI 53142-3832
(262) 658-1840
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20329-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39999000
—
WI
Enumeration date
02/14/2007
Last updated
07/09/2007
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