Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5638-33 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 5638-33 | WI |
N | 363LW0102X | Nurse Practitioner - Women's Health | 5638-33 | WI |
NPI | 1063424257 |
---|---|
Provider Name | Ms. Katherine Margaret Callies |
First Address | Marinette, WI 54143-1123 |
Second Address | Marinette, WI 54143-4287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 19/06/2014 |