Individual
MARY M. BEATTY-ROLOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
N2919 CTY HWY QQ, WAUPACA, WI 54981
(715) 258-2108
(715) 942-2199
Mailing address
N2919 CTY HWY QQ, WAUPACA, WI 54981
(715) 258-2108
(715) 942-2199
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
107505-030
WI
363L00000X
Nurse Practitioner
Primary
3195
WI
363L00000X
Nurse Practitioner
3195-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3195
WI STATE LICENSE
WI
Enumeration date
08/29/2007
Last updated
08/26/2013
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