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Individual

TINA R GWITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5239 COUNTY RD S, LITTLE SUAMICO, WI 54141-8804
(920) 606-8004
(920) 826-2766
Mailing address
5239 COUNTY RD S, LITTLE SUAMICO, WI 54141-8804
(920) 606-8004
(920) 826-2766

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
31129-031
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
35042900
WI
Enumeration date
10/31/2007
Last updated
10/31/2007
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