Provider Demographics
NPI:1003171802
Name:WITTENBERGER, BRIGITTE ELISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:ELISE
Last Name:WITTENBERGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 BROOKSIDE DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-2847
Mailing Address - Country:US
Mailing Address - Phone:920-214-3423
Mailing Address - Fax:
Practice Address - Street 1:318 BROOKSIDE DR UNIT 6
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-2847
Practice Address - Country:US
Practice Address - Phone:920-214-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309698-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI309698-31OtherNURSING LICENSE