MEDICARE: MRS. MARY KAY MING APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP 9346964	FL
2	363LA2200X	Adult Health Nurse Practitioner	CNP 3836	MN

General Provider Information

NPI Number	:	1053636928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KAY MING APNP

Provider Business Mailing Address
First Line	:	W8023 140TH AVE
Second Line	:
City	:	HAGER CITY
State	:	WI
Zip	:	54014-8077
Country	:	US
Telephone Number	:	715-215-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	W8023 140TH AVE
Second Line	:
City	:	HAGER CITY
State	:	WI
Zip	:	54014-8077
Country	:	US
Telephone Number	:	715-215-0447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	02/14/2017

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