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NPI Code Detail

MEDICARE: MS. MARY BERNAU-EIGEN R.N.

MEDICARE: MS. MARY BERNAU-EIGEN R.N.
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
1363L00000XNurse Practitioner48907-030WI

General Provider Information

NPI Number : 1215050471
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY BERNAU-EIGEN R.N.
Provider Business Mailing Address
First Line : 2958 S MABBETT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-2525
Country : US
Telephone Number : 414-481-9574
Fax Number :
Provider Business Practice Location Address
First Line : 2207 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1923
Country : US
Telephone Number : 414-931-8181
Fax Number : 414-931-0063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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