Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 10353-33 | WI |
N | 363L00000X | Nurse Practitioner | 194312-30 | WI |
NPI | 1003417726 |
---|---|
Provider Name | Maureen J Mayer |
First Address | Madison, WI 53717-1213 |
Second Address | Madison, WI 53717-1213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2020 |
Last Update Date | 15/04/2021 |