Individual
MRS. MARY VANDENBOSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
N4981 FRENCH RD, SEYMOUR, WI 54165-8349
(920) 733-9215
Mailing address
N4981 FRENCH RD, SEYMOUR, WI 54165-8349
(920) 733-9215
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
28151-031
WI
Other
Enumeration date
07/30/2007
Last updated
07/30/2007
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