Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 154342 | MN |
NPI | 1043694276 |
---|---|
Provider Name | Michael Litrenta |
First Address | Green Bay, WI 54313-7469 |
Second Address | Green Bay, WI 54301-3526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 18/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6556 | (05) | WI |