Healthcare Provider Details

I. General information

NPI: 1659346559
Provider Name (Legal Business Name): MARIA A DENU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 SUNRISE DR
SPRING GREEN WI
53588-9286
US

IV. Provider business mailing address

436 SUNRISE DR
SPRING GREEN WI
53588-9286
US

V. Phone/Fax

Practice location:
  • Phone: 608-588-2502
  • Fax:
Mailing address:
  • Phone: 608-588-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number572
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: