Healthcare Provider Details

I. General information

NPI: 1942508882
Provider Name (Legal Business Name): ARTEALIA V. MABON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E NORTH AVE COLUMBIA ST. MARY'S FAMILY MEDICINE
MILWAUKEE WI
53212-3515
US

IV. Provider business mailing address

1121 E NORTH AVE COLUMBIA ST. MARY'S FAMILY MEDICINE
MILWAUKEE WI
53212-3515
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-6500
  • Fax: 414-267-3892
Mailing address:
  • Phone: 414-267-6500
  • Fax: 414-267-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172754-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6559
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: