Individual
MARANDA RECORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
37822 US HIGHWAY 18, PRAIRIE DU CHIEN, WI 53821-8416
(608) 357-2500
Mailing address
37822 US HIGHWAY 18, PRAIRIE DU CHIEN, WI 53821-8416
(608) 357-2500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD22244
ME
207Q00000X
Family Medicine Physician
ME130179
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
06/19/2014
Last updated
06/15/2021
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