Provider Demographics
NPI:1427835578
Name:MAINVEL, ANITA LOIS (CPM, LM)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LOIS
Last Name:MAINVEL
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24959 MORRIS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581
Mailing Address - Country:US
Mailing Address - Phone:608-639-0347
Mailing Address - Fax:
Practice Address - Street 1:24959 MORRIS VALLEY RD
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581
Practice Address - Country:US
Practice Address - Phone:608-639-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife