Provider Demographics
NPI:1871829531
Name:UY, MARY-KATE DODGE (APNP)
Entity Type:Individual
Prefix:
First Name:MARY-KATE
Middle Name:DODGE
Last Name:UY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1975
Mailing Address - Country:US
Mailing Address - Phone:414-831-6877
Mailing Address - Fax:414-831-6765
Practice Address - Street 1:1840 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1975
Practice Address - Country:US
Practice Address - Phone:414-831-6877
Practice Address - Fax:414-831-6765
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3885-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health