Provider Demographics
NPI:1649319542
Name:MARAIA, TAURA (APNP)
Entity type:Individual
Prefix:
First Name:TAURA
Middle Name:
Last Name:MARAIA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 INGALLS RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4321
Mailing Address - Country:US
Mailing Address - Phone:715-232-9554
Mailing Address - Fax:
Practice Address - Street 1:800 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2734
Practice Address - Country:US
Practice Address - Phone:715-232-2388
Practice Address - Fax:715-232-1132
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1786-033363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1786-033OtherNURSE PRACTITIONER