Provider Demographics
NPI:1649423799
Name:MARIS, DENISE GREBE (FNP-BC APNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:GREBE
Last Name:MARIS
Suffix:
Gender:F
Credentials:FNP-BC APNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:GREBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC APNP
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-319-3000
Mailing Address - Fax:
Practice Address - Street 1:2311 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4445
Practice Address - Country:US
Practice Address - Phone:414-319-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-01
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3530-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily