Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4366 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4366 | WI |
NPI | 1013206663 |
---|---|
Provider Name | Laurel R Marek |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Milwaukee, WI 53233-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 02/12/2021 |