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NPI Code Detail

MEDICARE: MARY M JADIN NP

MEDICARE: MARY M JADIN NP
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
1363L00000XNurse PractitionerPAR-0000939661WI

General Provider Information

NPI Number : 1164379152
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY M JADIN NP
Provider Business Mailing Address
First Line : 3187 TRINITY CT
Second Line :
City : DE PERE
State : WI
Zip : 54115-2785
Country : US
Telephone Number : 920-655-3069
Fax Number :
Provider Business Practice Location Address
First Line : 1630 COMMANCHE AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-5753
Country : US
Telephone Number : 920-433-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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