Provider Demographics
NPI:1013197979
Name:NEFF, MARIRUTH (FNP)
Entity Type:Individual
Prefix:
First Name:MARIRUTH
Middle Name:
Last Name:NEFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIRUTH
Other - Middle Name:
Other - Last Name:PHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:2793 LINEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7152
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:2793 LINEVILLE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-7152
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3254-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467583278OtherOMC NPI
WI390848401050OtherCMH ANTHEM
WI11014110Medicaid
WI101863-030OtherRN LIC
WI1851477913OtherCMH NPI
WI36053600Medicaid
WI36053600Medicaid
WI390848401050OtherCMH ANTHEM
WI52Z310Medicare Oscar/Certification