Individual
MARY KATE BANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2000 N DEWEY AVE, REEDSBURG, WI 53959-1049
(414) 852-1726
Mailing address
9615 HARVEST MOON LN APT 302, VERONA, WI 53593-9676
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4723-23
WI
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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