Healthcare Provider Details

I. General information

NPI: 1023154150
Provider Name (Legal Business Name): MARY ANN MOWERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 S 27TH ST STE 400
GREENFIELD WI
53221-2653
US

IV. Provider business mailing address

4931 S 27TH ST STE 400
GREENFIELD WI
53221-2653
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-7200
  • Fax: 414-672-7400
Mailing address:
  • Phone: 414-672-7200
  • Fax: 414-672-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73829-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: