MRS. Marina Deatherage
NPI #1538706858 in Lake Geneva, Wisconsin
Provider Information
- NPI Number
- 1538706858
- Entity Type
- Individual
- Name
- MRS. Marina Deatherage
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Nurse Practitioner
- Enumeration Date
- Dec 5, 2019
- Last Updated
- Nov 30, 2021
Practice Location
- Address
- 146 E GENEVA SQ
- City
- Lake Geneva
- State
- Wisconsin
- ZIP Code
- 53147-9694
- Phone
- (262) 249-4660
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
| Nurse Practitioner |
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