Healthcare Provider Details

I. General information

NPI: 1295390805
Provider Name (Legal Business Name): PAYTON M MOHR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAYTON TEPP

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARK ST
MADISON WI
53715-1830
US

IV. Provider business mailing address

700 S PARK ST
MADISON WI
53715-1830
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2900
  • Fax:
Mailing address:
  • Phone: 608-260-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9426
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226494-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: