Individual
MRS. GRACE Y KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10850 N ORIOLE LN, MEQUON, WI 53092-4912
(262) 442-0754
(800) 319-4979
Mailing address
10850 N ORIOLE LN, MEQUON, WI 53092-4912
(262) 442-0754
(800) 319-4979
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
314375-031
WI
Other
Enumeration date
06/13/2012
Last updated
06/13/2012
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