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Individual

MARY K LEASE

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
1037 LINCOLN RD, OREGON, WI 53575-3464
(608) 835-1105
Mailing address
1037 LINCOLN RD, OREGON, WI 53575-3464
(608) 835-1105

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38293000
WI
Enumeration date
03/31/2006
Last updated
07/09/2007
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