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Individual

MS. MARY K. YELLICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APNP

Contact information

Practice address
285 FOREST GROVE DR, STE 124, PEWAUKEE, WI 53072-3716
(262) 329-8100
Mailing address
285 FOREST GROVE DR, STE 124, PEWAUKEE, WI 53072-3716
(414) 352-3100

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1417
WI
363LF0000X
Family Nurse Practitioner
Primary
1417
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1508812918
WI
05
36009400
WI
Enumeration date
05/26/2006
Last updated
06/07/2023
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