Provider Demographics
NPI:1336448323
Name:BRENEMAN, MIKAYLA ANN (CPM, LM)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ANN
Last Name:BRENEMAN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2086 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-9406
Mailing Address - Country:US
Mailing Address - Phone:920-229-7792
Mailing Address - Fax:
Practice Address - Street 1:W2086 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-9406
Practice Address - Country:US
Practice Address - Phone:920-229-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife