Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 6486-33 | WI |
NPI | 1003317835 |
---|---|
Provider Name | Mrs. Kelly Elizabeth Tomaszewski |
First Address | Brookfield, WI 53045-4708 |
Second Address | Milwaukee, WI 53215-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2018 |
Last Update Date | 19/07/2021 |