Basic Information
| Provider Information | |||||||||
| NPI: | 1588955041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONE | ||||||||
| FirstName: | MAHITA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W SILVER SPRING DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532094217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144619250 | ||||||||
| FaxNumber: | 4144613553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W SILVER SPRING DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532094217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144619250 | ||||||||
| FaxNumber: | 4144613553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2011 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9999-999 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 142515-030 | WI | N | Nursing Service Providers | Registered Nurse |
No ID Information.