Provider Demographics
NPI:1467562686
Name:HINTERMEYER, MARY (RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:HINTERMEYER
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:BONE MARROW TRANSPLANT
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3518
Mailing Address - Country:US
Mailing Address - Phone:414-266-6293
Mailing Address - Fax:414-266-3682
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:BONE MARROW TRANSPLANT
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3518
Practice Address - Country:US
Practice Address - Phone:414-266-6293
Practice Address - Fax:414-266-3682
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1420-033363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467562686Medicaid
WI1467562686Medicaid
WI736012627Medicare PIN
WI1467562686Medicaid