MARY J DERSE-HAYES (NPI# 1679675557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679675557 |
| Entity Type | Individual |
| Full Name | MARY J DERSE-HAYES |
| Credential | P.A. |
| Practice Address |
2350 N Lake Dr Suite 302 Milwaukee WI 53211-4528 |
| Mailing Address |
788 N Jefferson St Suite 300/attn. Kaaren Butzen Milwaukee WI 53202-3718 |
| Practice Telephone | 4142987104 |
| Practice Fax Number | 4142987117 |
| Mailing Telephone | 4142728950 |
| Mailing Fax Number | 4142252929 |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2016-11-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2046 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1679675557 | 05 |
| Street Address |
2350 N LAKE DR SUITE 302 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53211-4528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194721407 | Nguyen H Phan | Internal Medicine | 2350 N Lake Dr, Ste 206, Milwaukee, WI 53211-4528 | 2005-06-22 |
| 1326650698 | Dylan Henry Menefee | Physician Assistant | 2350 N Lake Dr, Milwaukee, WI 53211-4528 | 2020-08-18 |
| 1659936169 | Cadie Leigh Roszak | Nurse Practitioner | 2350 N Lake Dr, Milwaukee, WI 53211-4528 | 2019-05-09 |
| 1457884165 | Shelly A. Boyd | Nurse Practitioner | 2350 N Lake Dr, Suite 302, Milwaukee, WI 53211-4528 | 2017-04-10 |
| 1043663818 | Kelly Brock | Physician Assistant | 2350 N Lake Dr, Suite 206, Milwaukee, WI 53211-4528 | 2016-07-18 |
| 1376996397 | Jennifer Gallagher | Physician Assistant | 2350 N Lake Dr, Suite 206, Milwaukee, WI 53211-4528 | 2016-07-14 |
| 1104285873 | Catherine Bares | Nurse Practitioner | 2350 N Lake Dr, Suite 100, Milwaukee, WI 53211-4528 | 2016-02-23 |
| 1578921375 | Heather Bastjan | Nurse Practitioner | 2350 N Lake Dr, Suite 500, Milwaukee, WI 53211-4528 | 2016-02-08 |
| 1033586292 | Angela Kraus | Nurse Practitioner | 2350 N Lake Dr, Suite 302, Milwaukee, WI 53211-4528 | 2015-08-24 |
| 1871974964 | Tatyana Trendafilova Radulovic | Nurse Practitioner | 2350 N Lake Dr, Suite 302, Milwaukee, WI 53211-4528 | 2015-06-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821602335 | Gabriella Caitrin Emanuele | Occupational Therapist | Harborchase of Shorewood, 1111 E Capitol Drive, Shorewood, WI 53211 | 2020-09-02 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1861043952 | Rosina Bloomingdale Norton | Nurse Practitioner | 1921 E Harford Ave, Milwaukee, WI 53211 | 2019-09-20 |
| 1528556255 | Renee Reckelberg | Specialist/Technologist | 3409 North Downer Avenue, Pavilion, Suite 350, Milwaukee, WI 53211 | 2018-04-27 |
| 1700325602 | Wisconsin Vision, Inc. | Optometrist | 4163 N Oakland Ave, Shorewood, WI 53211 | 2017-02-13 |
| 1750827556 | Daniel Butz M.d., S.c. | Plastic Surgery | 2350 N Lake Dr Ste 304, Milwaukee, WI 53211 | 2017-01-17 |
| 1528517232 | Therese Simonis | Speech-Language Pathologist | 2390 N Lake Drive, Milwaukee, WI 53211 | 2016-09-23 |
| 1982075701 | Katie Michel | Specialist/Technologist | 3409 N. Downer Ave, Milwaukee, WI 53211 | 2015-10-20 |
| 1255776365 | Sarah Elizabeth Brill | Social Worker | 4433 N Oakland Ave Ste D, Shorewood, WI 53211 | 2013-05-02 |
| 1679814537 | Nicole Anne Parulski | Physical Therapist | 2301 North Lake Dr, Milwaukee, WI 53211 | 2013-03-01 |
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| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386257194 | Harrison R Pham | Physician Assistant | 214 E Florida St Apt 526, Milwaukee, WI 53204-1657 | 2020-08-31 |
| 1942824602 | Rebecca Frances Hasler | Physician Assistant | 2368 N Humboldt Blvd, Milwaukee, WI 53212-3524 | 2020-05-28 |
| 1194355784 | Ashley Bishop Henning | Physician Assistant | 2350 N Lake Dr Ste 404, Milwaukee, WI 53211-4528 | 2020-01-22 |
| 1902457575 | Kathryn Kasper | Physician Assistant | 2408 N Buffum St, Milwaukee, WI 53212-2902 | 2019-09-25 |
| 1972151314 | Kelly J Meyer | Physician Assistant | 2900 W Oklahoma Ave Ste 414, Milwaukee, WI 53215-4330 | 2019-08-28 |
| 1659923795 | Mikayla Preissner | Physician Assistant | 788 N Jefferson St Ste 401, Milwaukee, WI 53202-3718 | 2019-07-09 |
| 1245892124 | Emily Mason | Physician Assistant | 2901 W Kk River Pkwy Ste 507, Milwaukee, WI 53215-3660 | 2019-07-01 |
| 1124513528 | Kirby Kristine Hancock | Physician Assistant | 2350 N Lake Dr Ste 302, Milwaukee, WI 53211-4528 | 2018-06-27 |
| 1548785785 | Anne Gustavson | Physician Assistant | 5500 W Brown Deer Rd Ste 400, Milwaukee, WI 53223-2265 | 2017-08-09 |
| 1205359973 | Christina Marie Rende | Physician Assistant | 2350 N Lake Dr Ste 206, Milwaukee, WI 53211-4528 | 2017-07-24 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.