Provider Demographics
NPI:1659346559
Name:DENU, MARIA A (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:DENU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-9286
Mailing Address - Country:US
Mailing Address - Phone:608-588-2502
Mailing Address - Fax:
Practice Address - Street 1:436 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-9286
Practice Address - Country:US
Practice Address - Phone:608-588-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42926700Medicaid
001257120Medicare PIN
000257065Medicare PIN
001215430Medicare PIN
R97776Medicare UPIN
001213018Medicare PIN