Individual
MARILEE THORESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5249 E TERRACE DR, MADISON, WI 53718-8339
(608) 222-9777
Mailing address
1265 JOHN Q HAMMONS DR, MADISON, WI 53717-1941
(608) 251-4156
(608) 257-3842
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00316
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42908200
—
WI
Enumeration date
07/20/2006
Last updated
07/30/2013
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