Individual
MARY Y. ANSARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 656-2011
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
(262) 787-4026
(262) 782-6040
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
72323
WI
367500000X
Certified Registered Nurse Anesthetist
026133
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43399500
—
WI
01
—
P00480380
RAIL ROAD MEDICARE
—
Enumeration date
10/09/2007
Last updated
02/09/2009
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