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General NPI Number Information
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NPI Number | 1073504593
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Entity Type | Individual
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Provider Name | MARY E FAZIO R.N.
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Gender | Female
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4520 N ARDMORE AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-1401
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Country | US
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Telephone | 414-870-4121
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Fax | 414-961-2435
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Provider Business Mailing Address
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Address Line | 4520 N ARDMORE AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-1401
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Country | US
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Telephone | 414-870-4121
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Fax | 414-961-2435
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number |
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number |
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 163WP0218X
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Taxonomy Name | Pediatric Oncology Registered Nurse
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License Number |
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number |
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License Number State | WI
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