Individual
MARY NOLD-KLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6600
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
193-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42901700-PA-88/079
—
WI
Enumeration date
09/03/2006
Last updated
03/17/2018
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