Provider Demographics
NPI:1396976254
Name:PRESCOTT, MARK ANDREW (RN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:PRESCOTT
Suffix:
Gender:M
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:E13616 IDLEWILD RD
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:WI
Mailing Address - Zip Code:53561-9556
Mailing Address - Country:US
Mailing Address - Phone:608-493-2533
Mailing Address - Fax:
Practice Address - Street 1:E13616 IDLEWILD RD
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:WI
Practice Address - Zip Code:53561-9556
Practice Address - Country:US
Practice Address - Phone:608-493-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130297030163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35071300Medicaid