Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 113 - 033 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 113 - 033 | WI |
N | 363LC1500X | Nurse Practitioner - Community Health | 113 - 033 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 113 - 033 | WI |
NPI | 1508942541 |
---|---|
Provider Name | Ms. Jane Antoinette Novitzke |
First Address | Park Falls, WI 54552-1922 |
Second Address | Park Falls, WI 54552-1922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43822500 | (05) | WI |