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General NPI Number Information
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NPI Number | 1043654288
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Entity Type | Individual
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Provider Name | MAUREEN ANN MCNULTY L.AC., LMT, DIPL OM
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 148 EAST STATE STREET SUITE A
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City | BURLINGTON
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State | WI
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Zip | 53105
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Country | US
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Telephone | 773-677-8458
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Fax | 262-995-1422
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Provider Business Mailing Address
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Address Line | 148 EAST STATE STREET SUITE A
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City | BURLINGTON
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State | WI
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Zip | 53105
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Country | US
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Telephone | 773-677-8458
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Fax | 262-995-1422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 5060-146
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 660-055
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License Number State | WI
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