Individual
MR. TIMOTHY A MOUREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP CDE
Contact information
Practice address
525 AIRPORT DR, ONEIDA, WI 54155-9035
(920) 869-2711
Mailing address
PO BOX 365, ONEIDA, WI 54155-0365
(920) 869-2711
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
91719
WI
363L00000X
Nurse Practitioner
Primary
446
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43838600
—
WI
01
—
500001880
RAILROAD MEDICARE
WI
Enumeration date
10/11/2005
Last updated
11/02/2020
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