Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 093006205N9 NNP-PP | OR |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 3563-033 | WI |
NPI | 1043351778 |
---|---|
Provider Name | Ms. Georgia R. Ditzenberger |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 14/12/2015 |