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Individual

MR. KELLY JONATHON DOUCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
333 PINE RIDGE BLVD, WAUSAU, WI 54401-4102
(715) 845-5505
Mailing address
3106 SANDGATE CT # 54476, WESTON, WI 54476-5686
(920) 574-8003

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
127347
WI

Other

Enumeration date
08/19/2019
Last updated
09/20/2019
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