Provider Demographics
NPI:1205123882
Name:PRONOLD, MARIANNE (RN)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:PRONOLD
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 1:9718 W TERESA LN
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-4652
Mailing Address - Country:US
Mailing Address - Phone:414-353-4044
Mailing Address - Fax:
Practice Address - Street 1:9718 W TERESA LN
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-4652
Practice Address - Country:US
Practice Address - Phone:414-353-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI88844-030163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice