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1548560667
KELLY LYNNETTE NUCKOLLS
MADISON, WI
NPI
1548560667
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Former Name
KELLY LYNETTE MASSA
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
133V00000X Dietitian, Registered
(Licence: WI 976210)
Enumeration Date
2010-10-22
Last Update Date
2010-10-25
Business Address
-- KELLY LYNNETTE NUCKOLLS MS RD
600 HIGHLAND AVE MC 2433
MADISON, WI 53792-1530
Phone number: 608-662-0817
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Mailing Address
-- KELLY LYNNETTE NUCKOLLS MS RD
600 HIGHLAND AVE MC 2433
MADISON, WI 53792-1530
Phone number: 608-662-0817
Copy
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