Individual
MS. KELLY MARIE QUANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
11270 N PORT WASHINGTON RD, MEQUON, WI 53092-3410
(262) 241-1022
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4290-33
WI
363LF0000X
Family Nurse Practitioner
4290-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100014882
—
WI
Enumeration date
12/11/2010
Last updated
04/15/2024
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