MEDICARE: MARIS PERNSTEINER

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	163W00000X	Registered Nurse	190798	WI

General Provider Information

NPI Number	:	1699606863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIS PERNSTEINER

Provider Business Mailing Address
First Line	:	1236 KENNEDY ST
Second Line	:
City	:	RIB LAKE
State	:	WI
Zip	:	54470-9457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 KENNEDY ST
Second Line	:
City	:	RIB LAKE
State	:	WI
Zip	:	54470-9457
Country	:	US
Telephone Number	:	715-513-7573
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “ MARIS PERNSTEINER ” Practice Location

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