Individual
MRS. MARY GRACE ELLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
811 HARDING ST, WAUPACA, WI 54981-2012
(715) 258-6385
(715) 258-6409
Mailing address
811 HARDING STREET, WAUPACA, WI 54981
(715) 258-6385
(715) 258-6409
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
12346230
WI
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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