Healthcare Provider Details

I. General information

NPI: 1902723125
Provider Name (Legal Business Name): MARY CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W GLEN RIVER RD
GLENDALE WI
53217-4163
US

IV. Provider business mailing address

925 W GLEN RIVER RD
GLENDALE WI
53217-4163
US

V. Phone/Fax

Practice location:
  • Phone: 414-303-0863
  • Fax:
Mailing address:
  • Phone: 414-303-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number103445-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: