Provider Demographics
NPI:1154395150
Name:CHECKAI, MARY BETH (APNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:CHECKAI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:SUITE 250 WAUKESHA HEALTH CARE INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:ROOM SO173 COMMUNITY NURSING CLINIC AT WCTC
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-4601
Practice Address - Country:US
Practice Address - Phone:262-695-1888
Practice Address - Fax:262-695-1884
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68275Medicare ID - Type Unspecified
WIS52094Medicare UPIN