Provider Demographics
NPI:1881756849
Name:HAUSWIRTH, MARILYN ANN (RN REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ANN
Last Name:HAUSWIRTH
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4533 SKYLARK LN
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2909
Mailing Address - Country:US
Mailing Address - Phone:414-421-6243
Mailing Address - Fax:414-421-5234
Practice Address - Street 1:4533 SKYLARK LN
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2909
Practice Address - Country:US
Practice Address - Phone:414-421-6243
Practice Address - Fax:414-421-5234
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91284030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38208300Medicaid