Provider Demographics
NPI:1811696891
Name:EIFERT, MARY MCCALEB
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MCCALEB
Last Name:EIFERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E WILSON ST APT 1000
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4645
Mailing Address - Country:US
Mailing Address - Phone:509-393-3832
Mailing Address - Fax:
Practice Address - Street 1:725 HEARTLAND TRL STE 301
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1978
Practice Address - Country:US
Practice Address - Phone:608-205-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program