Provider Demographics
NPI:1386681500
Name:MAYO, DEBORAH A (APNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:MAYO
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 1:3734 - 7TH AV #12
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140
Mailing Address - Country:US
Mailing Address - Phone:262-654-9370
Mailing Address - Fax:262-654-9379
Practice Address - Street 1:11414 W PARK PL
Practice Address - Street 2:STE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3500
Practice Address - Country:US
Practice Address - Phone:414-292-7060
Practice Address - Fax:414-973-2090
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1856363LF0000X, 363LP0808X
WI1856-033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43981100Medicaid
WI000732165Medicare PIN