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General NPI Number Information
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NPI Number | 1871122556
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Entity Type | Individual
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Provider Name | MARY KOFIGAH 10020 - 33 NP
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Gender | Female
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 946 N VAN BUREN ST
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City | MILWAUKEE
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State | WI
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Zip | 53202-3216
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Country | US
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Telephone | 414-671-9355
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Fax | 888-376-4067
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Provider Business Mailing Address
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Address Line | 946 N VAN BUREN ST
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City | MILWAUKEE
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State | WI
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Zip | 53202-3216
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Country | US
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Telephone | 414-671-9355
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Fax | 888-376-4067
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1002033
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2024001821
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License Number State | WI
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