Individual
MARY J DALZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8230
(920) 926-8997
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8230
(920) 926-8997
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5008
WI
363LA2200X
Adult Health Nurse Practitioner
Primary
5008
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942552658
—
WI
Enumeration date
10/04/2012
Last updated
04/23/2025
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