Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 11115 | WI |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 11115-33 | WI |
NPI | 1154094019 |
---|---|
Provider Name | Marie Margaret Ganiere |
First Address | New Berlin, WI 53151-4700 |
Second Address | Racine, WI 53405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 11/02/2022 |