Provider Demographics
NPI:1962493635
Name:CAIRO, MARY JAMIE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JAMIE
Last Name:CAIRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:CAIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:6811 118TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8420
Practice Address - Country:US
Practice Address - Phone:262-857-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00823712OtherRR MEDICARE
WI43904300Medicaid
002232080Medicare ID - Type Unspecified
WI019940458Medicare PIN
S48429Medicare UPIN