Search › Wisconsin › 363L00000X
Marina Deatherage
NPI 1538706858 · on the registry since 2019
Practice
- Address
- 146 E Geneva Sq
Lake Geneva, WI 53147 - Phone
- (262) 249-4660
- Organisation at this address
- Aurora Pharmacy Inc
Aurora Medical Group Inc
Aurora Medical Group, Inc.Inferred from a shared address, not stated in the registry. - Clinicians at this address
- 46
Additional practice sites
- 3915 Oglesby Ave, Gurnee, IL
Registry record
- Primary taxonomy
- 363L00000X
363L00000X
- Also registered as
- 363LF0000X
- Licence states on file
- IL, WI
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2021-11-30
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin