Healthcare Provider Details

I. General information

NPI: 1871412783
Provider Name (Legal Business Name): MARANDA MUMMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 AMS CT
GREEN BAY WI
54313-9704
US

IV. Provider business mailing address

2740 HILLSBOROUGH CT
GREEN BAY WI
54311-5433
US

V. Phone/Fax

Practice location:
  • Phone: 920-504-3386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: