Provider Demographics
NPI:1912347170
Name:MAYHALL, KASI SAVAGE (FNP)
Entity Type:Individual
Prefix:
First Name:KASI
Middle Name:SAVAGE
Last Name:MAYHALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 N MAYFAIR RD
Mailing Address - Street 2:MCW PAIN MANAGEMENT CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3465
Mailing Address - Country:US
Mailing Address - Phone:414-955-7601
Mailing Address - Fax:414-955-6020
Practice Address - Street 1:959 N MAYFAIR RD
Practice Address - Street 2:MCW PAIN MANAGEMENT CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3465
Practice Address - Country:US
Practice Address - Phone:414-955-7601
Practice Address - Fax:414-955-6020
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI221761363LF0000X
WI6412363LF0000X
LAAP07415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily