Healthcare Provider Details

I. General information

NPI: 1588955041
Provider Name (Legal Business Name): MAHITA L GONE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N 87TH ST
MILWAUKEE WI
53226-3586
US

IV. Provider business mailing address

840 N 87TH ST
MILWAUKEE WI
53226-3586
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-2018
  • Fax: 414-461-3553
Mailing address:
  • Phone: 414-805-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number142515-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9999-999
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4421-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: