Healthcare Provider Details

I. General information

NPI: 1356625263
Provider Name (Legal Business Name): MARY ANN MUZI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN KIRSCHNER

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-5111
  • Fax:
Mailing address:
  • Phone: 414-384-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4629
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: