Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1898 | WI |
NPI | 1003818857 |
---|---|
Provider Name | Mrs. Brenda B. Mittelsteadt |
First Address | Wausau, WI 54401-7803 |
Second Address | Wausau, WI 54401-7803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 07/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43940600 | (05) | WI |
P29421 | (02) | WI |