Provider Demographics
NPI:1043047616
Name:USMAN, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:USMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1809 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3403
Mailing Address - Country:US
Mailing Address - Phone:608-640-8842
Mailing Address - Fax:
Practice Address - Street 1:1809 BOYD AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3403
Practice Address - Country:US
Practice Address - Phone:608-640-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility