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General NPI Number Information
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NPI Number | 1386647246
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Entity Type | Individual
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Provider Name | MARY LISA LANDWEHR MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 2829 COUNTY HIGHWAY I SUITE 2
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-2652
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Country | US
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Telephone | 715-726-3096
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Fax | 715-726-3979
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Provider Business Mailing Address
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Address Line | 2829 COUNTY HIGHWAY I SUITE 2
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-4410
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Country | US
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Telephone | 715-726-3096
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Fax | 715-726-3979
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 45925
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License Number State | WI
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