Provider Demographics
NPI:1710090246
Name:SEBASTIAN, MARY ROSALIE (MS, APRN, BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROSALIE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 N DOWNER AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4253
Mailing Address - Country:US
Mailing Address - Phone:414-964-9200
Mailing Address - Fax:
Practice Address - Street 1:2577 N DOWNER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4253
Practice Address - Country:US
Practice Address - Phone:414-964-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73401-030163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health