1659367688 NPI number — ROSLYN DEE MCKAY WHNP

Table of content: ROSLYN DEE MCKAY WHNP (NPI 1659367688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659367688 NPI number — ROSLYN DEE MCKAY WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKAY
Provider First Name:
ROSLYN
Provider Middle Name:
DEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURGESS
Provider Other First Name:
ROSLYN
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659367688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 LIBERTY DRIVE
Provider Second Line Business Mailing Address:
MARSHFIELD CLINIC-WITTENBERG CENTER
Provider Business Mailing Address City Name:
WITTENBERG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-253-2119
Provider Business Mailing Address Fax Number:
715-253-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 LIBERTY DRIVE
Provider Second Line Business Practice Location Address:
MARSHFIELD CLINIC-WITTENBERG CENTER
Provider Business Practice Location Address City Name:
WITTENBERG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-253-2119
Provider Business Practice Location Address Fax Number:
715-253-2498
Provider Enumeration Date:
09/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  101834030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)