Provider Demographics
NPI:1821386590
Name:MAHRTYN, MONA ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:ELAINE
Last Name:MAHRTYN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5903
Mailing Address - Country:US
Mailing Address - Phone:715-869-8801
Mailing Address - Fax:
Practice Address - Street 1:1242 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5903
Practice Address - Country:US
Practice Address - Phone:715-869-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312659-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse