Provider Demographics
NPI:1043654288
Name:MCNULTY, MAUREEN ANN (LAC, LMT, DIPL OM)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANN
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:LAC, LMT, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST STATE STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105
Mailing Address - Country:US
Mailing Address - Phone:773-677-8458
Mailing Address - Fax:262-995-1422
Practice Address - Street 1:148 EAST STATE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105
Practice Address - Country:US
Practice Address - Phone:773-677-8458
Practice Address - Fax:262-995-1422
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5060-146225700000X
225700000X
WI660-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI817175493OtherUNITEDHEALTHCARE INSURANCE COMPANY