Provider Demographics
NPI:1932177292
Name:DEMUTH, MONICA J (APRN BC NP)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:J
Last Name:DEMUTH
Suffix:
Gender:F
Credentials:APRN BC NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2920 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53091-1944
Mailing Address - Country:US
Mailing Address - Phone:920-453-5416
Mailing Address - Fax:920-803-2990
Practice Address - Street 1:2920 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53091-1944
Practice Address - Country:US
Practice Address - Phone:920-453-5416
Practice Address - Fax:920-803-2990
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1555033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43956300Medicaid
WI43956300Medicaid
WI001060245Medicare ID - Type Unspecified