Provider Demographics
NPI:1730334335
Name:ROBISON-KAEDING, MARYANN (RN)
Entity type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:ROBISON-KAEDING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W UNION STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-1941
Mailing Address - Country:US
Mailing Address - Phone:262-745-7364
Mailing Address - Fax:815-624-0290
Practice Address - Street 1:715 W UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-1941
Practice Address - Country:US
Practice Address - Phone:262-745-7364
Practice Address - Fax:815-624-0290
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64142-030163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38248200Medicaid