Individual
MARY BETH WELLACH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
N3355 QUEST RD, JUNEAU, WI 53039-9686
(920) 696-3793
Mailing address
N3355 QUEST RD, JUNEAU, WI 53039-9686
(920) 696-3793
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20384-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39843900
—
WI
Enumeration date
03/14/2006
Last updated
07/08/2007
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