Provider Demographics
NPI:1033767751
Name:UBICK, MARYLEE J
Entity Type:Individual
Prefix:
First Name:MARYLEE
Middle Name:J
Last Name:UBICK
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 1:701 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-1717
Mailing Address - Country:US
Mailing Address - Phone:920-203-0603
Mailing Address - Fax:
Practice Address - Street 1:701 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1717
Practice Address - Country:US
Practice Address - Phone:920-203-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider