KELLY JONATHON DOUCK

WAUSAU, WI
NPI1447807086
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: WI  127347)
Enumeration Date2019-08-19
Last Update Date2019-09-20
Business Address
Mr. KELLY JONATHON DOUCK CRNA
333 PINE RIDGE BLVD
WAUSAU, WI 54401-4102
Phone number: 715-845-5505
Mailing Address
Mr. KELLY JONATHON DOUCK CRNA
3106 SANDGATE CT # 54476
WESTON, WI 54476-5686
Phone number: 920-574-8003