Healthcare Provider Details

I. General information

NPI: 1215476874
Provider Name (Legal Business Name): BETH MARIE PAPE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH MARIE SKUPNIEWITZ

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N8832 LEIGER LN
IXONIA WI
53036-9726
US

IV. Provider business mailing address

N8832 LEIGER LN
IXONIA WI
53036-9726
US

V. Phone/Fax

Practice location:
  • Phone: 414-534-7082
  • Fax:
Mailing address:
  • Phone: 414-534-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number157158-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7567-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: