Individual
MAUREEN MACCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6785
(715) 848-4600
(715) 845-5398
Mailing address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6785
(715) 848-4600
(715) 845-5398
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200775-30
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5890
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033524749
—
WI
01
—
200775-30
STATE LICENSE
CT
01
—
5890-33
STATE LICENSE
WI
Enumeration date
06/23/2014
Last updated
12/03/2014
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