Provider Demographics
NPI:1073504593
Name:FAZIO, MARY E (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:FAZIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 N ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1401
Mailing Address - Country:US
Mailing Address - Phone:414-870-4121
Mailing Address - Fax:414-961-2435
Practice Address - Street 1:4520 N ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1401
Practice Address - Country:US
Practice Address - Phone:414-870-4121
Practice Address - Fax:414-961-2435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X, 163WH1000X, 163WP0200X, 163WP0218X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WH1000XNursing Service ProvidersRegistered NurseHospice
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
Not Answered163WX0200XNursing Service ProvidersRegistered NurseOncology