Individual
MARY L THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11002 W PARK PL, MILWAUKEE, WI 53224-3615
(414) 365-8300
Mailing address
11002 W PARK PL, MILWAUKEE, WI 53224-3615
(414) 365-8300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
185282-30
WI
363L00000X
Nurse Practitioner
8349-33
WI
363LF0000X
Family Nurse Practitioner
Primary
185282
WI
363LF0000X
Family Nurse Practitioner
Primary
8349-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396248407
—
WI
Enumeration date
03/14/2018
Last updated
03/18/2026
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