Provider Demographics
NPI:1710140488
Name:LEMMENES, MARY GRACE (APNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GRACE
Last Name:LEMMENES
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4439 MEADOW ROAD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN
Mailing Address - State:WI
Mailing Address - Zip Code:53919
Mailing Address - Country:US
Mailing Address - Phone:920-346-2187
Mailing Address - Fax:
Practice Address - Street 1:N4439 MEADOW RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:WI
Practice Address - Zip Code:53919-9734
Practice Address - Country:US
Practice Address - Phone:920-346-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3188033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health