Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2977 | WI |
NPI | 1003938143 |
---|---|
Provider Name | Virginia H Trzebiatowski |
First Address | Stevens Point, WI 54481 |
Second Address | Waupaca, WI 54481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2977 | WI LICENSE # (01) | WI |