Individual
KELLY RAE VANDERMUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1381 BRAYDEN LN, DE PERE, WI 54115-9249
(920) 664-3734
Mailing address
2502 S ASHLAND AVE, GREEN BAY, WI 54304-5252
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4704-23
WI
Other
Enumeration date
06/19/2019
Last updated
12/05/2019
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