Provider Demographics
NPI:1194894568
Name:MONROE-MAYER, CORINNE BETH (RN)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:BETH
Last Name:MONROE-MAYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N 4232 LONG RD
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014
Mailing Address - Country:US
Mailing Address - Phone:920-849-4297
Mailing Address - Fax:
Practice Address - Street 1:N 4232 LONG RD
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014
Practice Address - Country:US
Practice Address - Phone:920-849-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI90277030163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39949500Medicaid