Healthcare Provider Details

I. General information

NPI: 1528141488
Provider Name (Legal Business Name): MARILYN ROSE MOTSZKO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 S SAINT JOSEPH AVE
ARCADIA WI
54612-1401
US

IV. Provider business mailing address

464 S SAINT JOSEPH AVE
ARCADIA WI
54612-1401
US

V. Phone/Fax

Practice location:
  • Phone: 608-323-3341
  • Fax:
Mailing address:
  • Phone: 608-323-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2131033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: