Individual
YIA LOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1201 GARFIELD AVE, LITTLE CHUTE, WI 54140-2048
(872) 231-3162
Mailing address
PO BOX 74008272, CHICAGO, IL 60674-8272
(872) 231-3162
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10354-33
WI
Other
Enumeration date
09/11/2020
Last updated
02/09/2026
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