Individual
MARY J FILLMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1521 GULL RD, KALAMAZOO, MI 49048-1640
(269) 226-5074
Mailing address
721 S WILMOTT ST, OTSEGO, MI 49078-1448
(630) 730-3898
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209008161
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
4704224949
MI
Other
Enumeration date
05/14/2010
Last updated
08/30/2023
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