Healthcare Provider Details

I. General information

NPI: 1104953348
Provider Name (Legal Business Name): MARY KASSEL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 CLARK ST
BROWNSVILLE WI
53006-2631
US

IV. Provider business mailing address

414 CLARK ST
BROWNSVILLE WI
53006-2631
US

V. Phone/Fax

Practice location:
  • Phone: 920-216-7773
  • Fax:
Mailing address:
  • Phone: 920-216-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number33667-031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: