Individual
MARY JOANN SPILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2400
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 531-2400
(920) 531-2450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209004508
IL
363L00000X
Nurse Practitioner
Primary
2144
WI
363LF0000X
Family Nurse Practitioner
2144
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
05
—
43988800
—
WI
01
—
F400254738
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
12/01/2005
Last updated
04/25/2023
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