Individual
MARY TELLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAS
Contact information
Practice address
2801 W KK RIVER PKWY STE 575, MILWAUKEE, WI 53215-5200
(414) 649-3240
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5920
WI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100085581
—
WI
Enumeration date
08/10/2018
Last updated
02/12/2025
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