Provider Demographics
NPI:1174839872
Name:NEUMAN, MARY LOU NONE
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:NONE
Last Name:NEUMAN
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 1:310 S PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1249
Mailing Address - Country:US
Mailing Address - Phone:920-565-3272
Mailing Address - Fax:
Practice Address - Street 1:310 S PERSHING ST
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1249
Practice Address - Country:US
Practice Address - Phone:920-565-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI97773-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse