Individual
MARY ALICE MUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
13750 W NATIONAL AVE, PROHEALTH CARE MEDICAL ASSOCIATES INC., NEW BERLIN, WI 53151-4588
(262) 789-1699
Mailing address
13750 W NATIONAL AVE, PROHEALTH CARE MEDICAL ASSOCIATES INC., NEW BERLIN, WI 53151-4588
(262) 789-1699
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
126341-30
WI
363L00000X
Nurse Practitioner
Primary
2862-033
WI
Other
Enumeration date
09/14/2006
Last updated
01/07/2014
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