Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5150-33 | WI |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 150638 | WI |
NPI | 1003169376 |
---|---|
Provider Name | Mary C Fox |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Green Bay, WI 54311-8349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2012 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100026969 | (05) | WI |