Provider Demographics
NPI:1053636928
Name:MING, MARY KAY (APNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:MING
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8023 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAGER CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54014-8077
Mailing Address - Country:US
Mailing Address - Phone:715-215-0447
Mailing Address - Fax:
Practice Address - Street 1:W8023 140TH AVE
Practice Address - Street 2:
Practice Address - City:HAGER CITY
Practice Address - State:WI
Practice Address - Zip Code:54014-8077
Practice Address - Country:US
Practice Address - Phone:715-215-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9346964363LA2200X
MNCNP 3836363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health