Healthcare Provider Details

I. General information

NPI: 1255971719
Provider Name (Legal Business Name): MAURA CLAIRE DODGE-GAARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6571 AFTER HOURS ROAD
BRULE WI
54820
US

IV. Provider business mailing address

4965 S COUNTY ROAD F
MAPLE WI
54854-9001
US

V. Phone/Fax

Practice location:
  • Phone: 608-383-3048
  • Fax:
Mailing address:
  • Phone: 715-815-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244984
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: