Provider Demographics
NPI:1558702233
Name:MARY L. FELTZ
Entity Type:Organization
Organization Name:MARY L. FELTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-652-2049
Mailing Address - Street 1:5958 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:WI
Mailing Address - Zip Code:54412-9004
Mailing Address - Country:US
Mailing Address - Phone:715-652-2049
Mailing Address - Fax:
Practice Address - Street 1:5958 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:WI
Practice Address - Zip Code:54412-9004
Practice Address - Country:US
Practice Address - Phone:715-652-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251J00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No305S00000XManaged Care OrganizationsPoint of Service