Provider Demographics
NPI:1942508882
Name:MABON, ARTEALIA V (APNP)
Entity type:Individual
Prefix:MISS
First Name:ARTEALIA
Middle Name:V
Last Name:MABON
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Gender:F
Credentials:APNP
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Mailing Address - Street 1:1121 E NORTH AVE
Mailing Address - Street 2:COLUMBIA ST. MARY'S FAMILY MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3515
Mailing Address - Country:US
Mailing Address - Phone:414-267-6500
Mailing Address - Fax:414-267-3892
Practice Address - Street 1:1121 E NORTH AVE
Practice Address - Street 2:COLUMBIA ST. MARY'S FAMILY MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3515
Practice Address - Country:US
Practice Address - Phone:414-267-6500
Practice Address - Fax:414-267-3892
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2015-09-18
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Provider Licenses
StateLicense IDTaxonomies
WI172754-30163W00000X
WI6559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942508882Medicaid