Individual
JESSICA L LIETZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1650 S 41ST ST, MANITOWOC, WI 54220-7316
(920) 320-2436
Mailing address
1650 S 41ST ST, MANITOWOC, WI 54220-3712
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13101-33
WI
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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