Individual
MARY MIKEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
156 MCKINLEY ST, TWO RIVERS, WI 54241-3242
(920) 860-1828
(920) 860-1828
Mailing address
156 MCKINLEY ST, TWO RIVERS, WI 54241-3242
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
321288-31
WI
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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