Individual
GORDON VITTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
425 PINE RIDGE BLVD, SUITE 211, WAUSAU, WI 54401-4123
(715) 845-5505
(715) 848-2884
Mailing address
425 PINE RIDGE BLVD, SUITE 211, WAUSAU, WI 54401-4123
(715) 845-5505
(715) 848-2884
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4565830
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29700
SECURITY HEALTH MEDICAID
WI
01
—
43274000
MANAGED HEALTH CARE
WI
05
—
43274000
—
WI
01
—
VITTONE
WPS
WI
Enumeration date
07/17/2006
Last updated
07/09/2007
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