Individual
KIM LEA CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 CHICAGO ST, DE PERE, WI 54115-3418
(920) 337-1032
Mailing address
2276 DOLLAR RD, DE PERE, WI 54115-9712
(920) 737-3601
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
123148-30
WI
Other
Enumeration date
05/26/2020
Last updated
05/26/2020
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