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1104044395
CONNIE LEE WORM
SHEBOYGAN, WI
NPI
1104044395
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: WI 86329-030)
Enumeration Date
2007-04-23
Last Update Date
2007-07-08
Business Address
-- CONNIE LEE WORM
2108 KOHLER MEMORIAL DR
SHEBOYGAN, WI 53081-3100
Phone number: 920-458-9401
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Mailing Address
-- CONNIE LEE WORM
3532 N 21ST ST
SHEBOYGAN, WI 53083-2807
Phone number: 920-458-6556
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