Basic Information
| Provider Information | |||||||||
| NPI: | 1487018883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASTERS | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BAKER | ||||||||
| OtherFirstName: | HANNAH | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | MEDICAL EDUCATION OFFICE CHILDREN'S CORPORATE CENTER | ||||||||
| Address2: | 999 N. 92ND ST., SUITE 730 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WISCONSIN | ||||||||
| PostalCode: | 53226 | ||||||||
| CountryCode: | UM | ||||||||
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| Practice Location | |||||||||
| Address1: | 999 NORTH 92ND STREET, SUITE 730 | ||||||||
| Address2: | MEDICAL EDUCATION OFFICE, CHILDREN'S CORPORATE CENTER | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142666800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.