Individual
REATA F MAYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
580 W COLLEGE AVE, MARQUETTE, MI 49855-2705
(906) 225-3406
(906) 225-3094
Mailing address
1347 ORTMAN RD, MARQUETTE, MI 49855
(906) 249-3999
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704128421
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103133127
—
MI
01
—
430024327
RAILROAD MEDICARE PIN
MI
01
—
43400500
WISC MEDICAID PIN
WI
01
—
RJ128421
BLUESHIELD PIN
MI
Enumeration date
11/17/2005
Last updated
02/05/2020
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