Provider Demographics
NPI:1730917378
Name:VINE, MARIA KATIA (MS,GC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:KATIA
Last Name:VINE
Suffix:
Gender:F
Credentials:MS,GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1350
Mailing Address - Country:US
Mailing Address - Phone:608-217-1030
Mailing Address - Fax:
Practice Address - Street 1:532 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1350
Practice Address - Country:US
Practice Address - Phone:608-690-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1519-61170300000X
WAGP61602945170300000X
ORGCP-T-10245495170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS