Individual
MARY J DERSE-HAYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2350 N LAKE DR, SUITE 302, MILWAUKEE, WI 53211-4528
(414) 298-7104
(414) 298-7117
Mailing address
788 N JEFFERSON ST, SUITE 300/ATTN. KAAREN BUTZEN, MILWAUKEE, WI 53202-3718
(414) 272-8950
(414) 225-2929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2046
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679675557
—
WI
Enumeration date
09/02/2006
Last updated
11/09/2016
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