Individual
MISS KYA LEE WELLNITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
299 SWEET GRASS DR, SUN PRAIRIE, WI 53590-3468
(608) 825-4474
Mailing address
N2860 MODE LN, FORT ATKINSON, WI 53538-8820
(920) 397-0791
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321714-31
WI
164W00000X
Licensed Practical Nurse
32171431
WI
Other
Enumeration date
07/17/2017
Last updated
07/17/2017
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