Provider Demographics
NPI:1538461181
Name:DROVER, MARY CLAIRE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLAIRE
Last Name:DROVER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2483 COUNTY ROAD F
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-9115
Mailing Address - Country:US
Mailing Address - Phone:920-361-2034
Mailing Address - Fax:
Practice Address - Street 1:2448 S 102ND ST STE 340
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2147
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1953-26174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1953-26OtherSTATE OF WISCONSIN DEPARTMENT OF REGULATIONS AND LICENSING
WI985857OtherNBCOT