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NPI Code Detail

MEDICARE: MARI C MATHERS

MEDICARE: MARI C MATHERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1053938548
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARI C MATHERS
Provider Business Mailing Address
First Line : N68W14788 PRUDENCE DR
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-0911
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3409 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-2934
Country : US
Telephone Number : 414-229-3914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2020
Last Update Date : 06/30/2020

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