MEDICARE: MARY ANN ROESELER L.AC.

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	171100000X	Acupuncturist	996-55	WI

General Provider Information

NPI Number	:	1093346629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN ROESELER L.AC.

Provider Business Mailing Address
First Line	:	4027 S 2ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4313
Country	:	US
Telephone Number	:	414-628-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	4027 S 2ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4313
Country	:	US
Telephone Number	:	414-628-2336
Fax Number	:

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

Provider Enumeration Date	:	02/02/2020
Last Update Date	:	02/02/2020

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Directions to “ MARY ANN ROESELER L.AC.” Practice Location

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