Provider Demographics
NPI:1902857709
Name:BECK METZGER, MARY K (APNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BECK METZGER
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 1:1541 ANNEX RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9803
Mailing Address - Country:US
Mailing Address - Phone:920-674-7442
Mailing Address - Fax:920-674-7460
Practice Address - Street 1:1541 ANNEX RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9803
Practice Address - Country:US
Practice Address - Phone:920-674-7442
Practice Address - Fax:920-674-7460
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1895-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1039346OtherPHYSICIANS PLUS
WI43944300Medicaid
WI1039346OtherPHYSICIANS PLUS
WI001254375Medicare PIN
WI43944300Medicaid
WI500021686Medicare PIN