Provider Demographics
NPI:1114626025
Name:DIETZMAN, KAITLIN CHRISTINE
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:CHRISTINE
Last Name:DIETZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5168 860TH ST
Mailing Address - Street 2:
Mailing Address - City:ELK MOUND
Mailing Address - State:WI
Mailing Address - Zip Code:54739-8200
Mailing Address - Country:US
Mailing Address - Phone:608-434-7989
Mailing Address - Fax:
Practice Address - Street 1:N5168 860TH ST
Practice Address - Street 2:
Practice Address - City:ELK MOUND
Practice Address - State:WI
Practice Address - Zip Code:54739-8200
Practice Address - Country:US
Practice Address - Phone:608-434-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232561163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical