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1164890596
MARY A MELLENTHIN
FOND DU LAC, WI
NPI
1164890596
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: WI 6501-33)
Enumeration Date
2015-09-02
Last Update Date
2020-12-07
Business Address
MARY A MELLENTHIN APNP
912 S HICKORY ST
FOND DU LAC, WI 54935-5530
Phone number: 920-907-3922
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Mailing Address
MARY A MELLENTHIN APNP
420 E DIVISION ST
FOND DU LAC, WI 54935-4560
Phone number: 920-926-5666
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