Individual
MARK WILLIAM DANTUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
3200 E RACINE ST, JANESVILLE, WI 53546-2343
(608) 371-8000
(608) 371-8939
Mailing address
500 W 190TH ST STE 400, GARDENA, CA 90248-4269
(714) 452-1961
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
8782-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407322084
—
WI
Enumeration date
10/22/2018
Last updated
11/06/2020
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