Healthcare Provider Details

I. General information

NPI: 1427984277
Provider Name (Legal Business Name): MARIAM CASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 CAMERON DR
MINOCQUA WI
54548-9109
US

IV. Provider business mailing address

7822 CAMERON DR
MINOCQUA WI
54548-9109
US

V. Phone/Fax

Practice location:
  • Phone: 715-439-3299
  • Fax:
Mailing address:
  • Phone: 715-439-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18496-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number18496-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR2484328
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: