MEDICARE: JONI MARTY

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	163WC1500X	Community Health Registered Nurse		WI

Other Identifiers

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

General Provider Information

NPI Number	:	1851569495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI MARTY

Provider Business Mailing Address
First Line	:	N3150 HWY 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-9397
Country	:	US
Telephone Number	:	608-328-9390
Fax Number	:	608-325-7575

Provider Business Practice Location Address
First Line	:	N3150 HWY 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-9397
Country	:	US
Telephone Number	:	608-328-9390
Fax Number	:	608-325-7575

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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Directions to “ JONI MARTY ” Practice Location

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