Healthcare Provider Details

I. General information

NPI: 1477907913
Provider Name (Legal Business Name): MAUREEN ROSE NIXON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N MAYFAIR RD SUITE 100
MILWAUKEE WI
53226-3255
US

IV. Provider business mailing address

1233 N MAYFAIR RD SUITE 100
MILWAUKEE WI
53226-3255
US

V. Phone/Fax

Practice location:
  • Phone: 414-944-2000
  • Fax: 414-944-2092
Mailing address:
  • Phone: 414-944-2000
  • Fax: 414-944-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6835-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: