Most Relevant Information
Provider Data
| NPI Number: | 1003802331 |
| Provider Name: | MARY R KELM NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 16033 |
Most Important Dates
| Enumeration Date: | 09/22/2005 |
| Last Updated: | 03/28/2016 |
Provider Practice Location
420 E DIVISION ST
FOND DU LAC
WI
549354560
Practice Location Phone/Fax
| Phone: | 9209268230 |
| Fax: |
Provider Mailing Location
420 E DIVISION ST
FOND DU LAC
WI
549354560
Provider Mailing Phone/Fax
| Phone: | 9209268340 |
| Fax: | 9209268370 |