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NPI Code Detail

MEDICARE: MARY L THEISEN NP

MEDICARE: MARY L THEISEN NP
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
1363LF0000XFamily Nurse Practitioner8349-33WI
2363L00000XNurse Practitioner8349-33WI
3163W00000XRegistered Nurse185282-30WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396248407
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY L THEISEN NP
Provider Business Mailing Address
First Line : 11002 W PARK PL
Second Line :
City : MILWAUKEE
State : WI
Zip : 53224-3615
Country : US
Telephone Number : 414-365-8300
Fax Number :
Provider Business Practice Location Address
First Line : 11002 W PARK PL
Second Line :
City : MILWAUKEE
State : WI
Zip : 53224-3615
Country : US
Telephone Number : 414-365-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2018
Last Update Date : 03/18/2026

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