MEDICARE: LORETTA N MARKUS

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	103T00000X	Psychologist
2	103T00000X	Psychologist	3907-57	WI

General Provider Information

NPI Number	:	1427495829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA N MARKUS

Provider Business Mailing Address
First Line	:	4321 W COLLEGE AVE STE 200
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-3968
Country	:	US
Telephone Number	:	920-716-7030
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 W COLLEGE AVE STE 200
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-3968
Country	:	US
Telephone Number	:	920-916-0730
Fax Number	:

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	01/29/2023

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Directions to “ LORETTA N MARKUS ” Practice Location

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