Provider Demographics
NPI:1568195006
Name:ULNESS, MARIAH GLORIA
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:GLORIA
Last Name:ULNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 LENZ RD
Mailing Address - Street 2:
Mailing Address - City:VALDERS
Mailing Address - State:WI
Mailing Address - Zip Code:54245-9619
Mailing Address - Country:US
Mailing Address - Phone:920-901-3415
Mailing Address - Fax:
Practice Address - Street 1:2835 LENZ RD
Practice Address - Street 2:
Practice Address - City:VALDERS
Practice Address - State:WI
Practice Address - Zip Code:54245-9619
Practice Address - Country:US
Practice Address - Phone:920-901-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program