Individual
MRS. CHRISTINE MARIE DONNELLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
308 N HIGH AVE, JEFFERSON, WI 53549-1017
(920) 674-2643
Mailing address
308 N HIGH AVE, JEFFERSON, WI 53549-1017
(920) 674-2643
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10839-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38227300
—
WI
Enumeration date
03/17/2006
Last updated
07/09/2007
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