MEDICARE: MAIA I MICHELS RN

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
1	163W00000X	Registered Nurse	174300-30	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174300-30	OTHER	WI	STATE OF WISCONSIN RN LICENSE

General Provider Information

NPI Number	:	1336583988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIA I MICHELS RN

Provider Business Mailing Address
First Line	:	9002 W LISBON AVE UNIT 312
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2733
Country	:	US
Telephone Number	:	414-962-0138
Fax Number	:

Provider Business Practice Location Address
First Line	:	9002 W LISBON AVE UNIT 312
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2733
Country	:	US
Telephone Number	:	414-962-0138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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Directions to “ MAIA I MICHELS RN” Practice Location

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