Provider Demographics
NPI:1184020877
Name:MAAG, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MAAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DELHI ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6320
Mailing Address - Country:US
Mailing Address - Phone:563-557-5991
Mailing Address - Fax:563-589-4078
Practice Address - Street 1:1515 DELHI ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6320
Practice Address - Country:US
Practice Address - Phone:563-557-5991
Practice Address - Fax:563-589-4078
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD138951367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered