Individual
MARIA DERKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
33 UNIVERSITY AVE, BEAVER DAM, WI 53916-8847
(920) 356-6936
Mailing address
N3901 STATE ROAD 26, WAUPUN, WI 53963-8847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1671-19
WI
Other
Enumeration date
12/06/2013
Last updated
12/06/2013
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