Mary Kofigah, 10020 - 33 NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2024001821 Issued in WI

Practice address

946 N Van Buren St
Milwaukee, WI 53202-3216

Phone

(414) 671-9355

Fax

(888) 376-4067

NPI assigned

Apr 5, 2020

Last updated

Mar 26, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleanslate Medical Group of Wisconsin SCGroup PAC ID 4284905134, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cleanslate Medical Group of Wisconsin, SC

  • Addiction Medicine (Internal Medicine) Physician
  • Glendale, WI
  • NPI 1518404854
  Medicare reassignment Care Compare group NPD
• Horizon Healthcare, Inc

  • Multi-Specialty Clinic/Center
  • Milwaukee, WI
  • NPI 1225052830
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  WI

  Medicare reassignment NPD
• Horizon Healthcare, Inc.

  • General Practice Physician
  • Racine, WI
  • NPI 1881085793

  Family

  NPD
• Optum Behavioral Care of Colorado, P.C.

  dba Sherman Counseling of Wisconsin

  • Counseling Psychologist
  • Appleton, WI
  • NPI 1487424826
  NPD
• Wi SHMH SC

  • Behavioral Neurology & Neuropsychiatry Physician
  • Brookfield, WI
  • NPI 1841031549
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1871122556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 N VAN BUREN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023216",
            "telephone_number": "414-671-9355",
            "fax_number": "888-376-4067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "946 N VAN BUREN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023216",
            "telephone_number": "414-671-9355",
            "fax_number": "888-376-4067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFIGAH",
        "first_name": "MARY",
        "name_prefix": "Miss",
        "credential": "10020 - 33 NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-05",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "1002033",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "2024001821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Drew Koeppl, CPNP-AC
• Raven A Koeppler, M.D.
• Kory D Koerner, M.D.
• Norman E Koerner, RPH
• David Koerten, CCP
• Vrisiis Kofina, DDS
• Dmitriy Kogan, M.D.
• Donna Kogler, MD
• Charles H Koh, M.D.
• T C Koh, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.