Individual
GNOUMA SIDIBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
718 WATER TOWER DR, MARSHALL, WI 53559-9041
(608) 446-3191
Mailing address
718 WATER TOWER DR, MARSHALL, WI 53559-9041
(608) 446-3191
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
32686131
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
874396284
—
WI
Enumeration date
01/12/2022
Last updated
01/12/2022
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