Provider Demographics
NPI:1003818857
Name:MITTELSTEADT, BRENDA B (BSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:B
Last Name:MITTELSTEADT
Suffix:
Gender:F
Credentials:BSN FNP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:B
Other - Last Name:PATEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP
Mailing Address - Street 1:4704 BAYBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6097
Mailing Address - Country:US
Mailing Address - Phone:715-843-0366
Mailing Address - Fax:715-322-2084
Practice Address - Street 1:4704 BAYBERRY ST
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-6097
Practice Address - Country:US
Practice Address - Phone:715-843-0366
Practice Address - Fax:715-322-2084
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43940600Medicaid
WI001039049Medicare ID - Type Unspecified
WI43940600Medicaid
WI43940600Medicare ID - Type Unspecified