Individual
STACIE LYN WITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
W8346 W 28TH RD, CRIVITZ, WI 54114-7372
(920) 373-0929
Mailing address
W8346 W 28TH RD, CRIVITZ, WI 54114-7372
(920) 373-0929
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
113611
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113611
—
WI
Enumeration date
07/11/2021
Last updated
07/11/2021
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