Mary Ann Bennett, R.N.
Individual provider Active NPI Registered Nurse · Omro, WI
NPI 1225255441 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1225255441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- Practice address
- 5442 Reighmoor Rd
Omro, WI 54963-9438 - Phone
- (920) 203-1877
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146620-030 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | WI | Yes |
Addresses
Primary practice location
5442 Reighmoor Rd
Omro, WI 54963-9438
Mailing address
5442 Reighmoor Rd
Omro, WI 54963-9438
Phone (920) 203-1877
Other providers in Omro, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.