Individual
MRS. KIM MARIE WILLISON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
2105 E ENTERPRISE AVE, STE 111, APPLETON, WI 54913
(920) 731-6611
(920) 731-6732
Mailing address
2105 E ENTERPRISE AVE, STE 111, APPLETON, WI 54913
(920) 731-6611
(920) 731-6732
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2608
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41265800
—
WI
Enumeration date
05/17/2006
Last updated
07/08/2007
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