Individual
MS. DESIRAE NICHOLE ALSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-4720
Mailing address
812 MADISON ST, BEAVER DAM, WI 53916-2622
(920) 296-4328
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
15506
WI
363LF0000X
Family Nurse Practitioner
F06240136
WI
Other
Enumeration date
06/06/2024
Last updated
07/15/2024
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