Provider Demographics
NPI:1215476874
Name:PAPE, BETH MARIE (NP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:PAPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:MARIE
Other - Last Name:SKUPNIEWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N8832 LEIGER LN
Mailing Address - Street 2:
Mailing Address - City:IXONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53036-9726
Mailing Address - Country:US
Mailing Address - Phone:414-534-7082
Mailing Address - Fax:
Practice Address - Street 1:N8832 LEIGER LN
Practice Address - Street 2:
Practice Address - City:IXONIA
Practice Address - State:WI
Practice Address - Zip Code:53036-9726
Practice Address - Country:US
Practice Address - Phone:414-534-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157158-30163W00000X
WI7567-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse