Provider Demographics
NPI:1952647547
Name:MARTY, MARY ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MARTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29652 COUNTY HIGHWAY V
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:WI
Mailing Address - Zip Code:54638
Mailing Address - Country:US
Mailing Address - Phone:608-387-0296
Mailing Address - Fax:
Practice Address - Street 1:1050 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1931
Practice Address - Country:US
Practice Address - Phone:608-847-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164631-30163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation