Provider Demographics
NPI:1548589328
Name:MARAKA, ABBEY J
Entity Type:Individual
Prefix:MS
First Name:ABBEY
Middle Name:J
Last Name:MARAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:J
Other - Last Name:VIEBAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23400
Mailing Address - Street 2:744 SOUTH WEBSTER AVE
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1630 COMMANCHE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-430-4780
Practice Address - Fax:920-430-4787
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148841367A00000X
WI4081.33363LP0808X
WI1606674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse