Healthcare Provider Details

I. General information

NPI: 1376471078
Provider Name (Legal Business Name): MARY J KLADE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N SALES ST
MERRILL WI
54452-3171
US

IV. Provider business mailing address

W6272 FOREST DR
MERRILL WI
54452-8705
US

V. Phone/Fax

Practice location:
  • Phone: 715-536-6101
  • Fax: 715-536-1788
Mailing address:
  • Phone: 715-218-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number98149-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: