Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2195-012 | WI |
NPI | 1225253628 |
---|---|
Provider Name | Dr. Margaret Mary Mertens |
First Address | Marshfield, WI 54449-2741 |
Second Address | Marshfield, WI 54449-2741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 24/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200415291 | TAX ID (01) | WI |
T62751 | (02) | WI |