Healthcare Provider Details

I. General information

NPI: 1437974268
Provider Name (Legal Business Name): MARIAH BEHR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

IV. Provider business mailing address

2413 E WEBSTER PL APT K
MILWAUKEE WI
53211-4152
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1111385-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: