Healthcare Provider Details

I. General information

NPI: 1457416752
Provider Name (Legal Business Name): MAUREEN LOUISE CAIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BELOIT MALL
BELOIT WI
53511
US

IV. Provider business mailing address

509 DORI CT
PECATONICA IL
61063
US

V. Phone/Fax

Practice location:
  • Phone: 608-361-6051
  • Fax: 608-361-6131
Mailing address:
  • Phone: 815-239-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: