Provider Demographics
NPI:1962911602
Name:CONNETT, MAREUM LUCINDA
Entity type:Individual
Prefix:MISS
First Name:MAREUM
Middle Name:LUCINDA
Last Name:CONNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARNEY
Other - Middle Name:L
Other - Last Name:COGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3440 OAKWOOD HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-214-2525
Mailing Address - Fax:
Practice Address - Street 1:3440 OAKWOOD HILLS PKWY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7698
Practice Address - Country:US
Practice Address - Phone:715-214-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI221988-30207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty