Provider Demographics
NPI:1003164658
Name:FINNERTY, MARY K
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:FINNERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W VLIET ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2453
Mailing Address - Country:US
Mailing Address - Phone:414-231-4000
Mailing Address - Fax:414-231-4011
Practice Address - Street 1:3220 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2453
Practice Address - Country:US
Practice Address - Phone:414-231-4000
Practice Address - Fax:414-231-4011
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9142-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse