Provider Demographics
NPI:1275164667
Name:BARTACZEWICZ, BRIANNA L
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:L
Last Name:BARTACZEWICZ
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 1:4320 S WOODSVIEW CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-3645
Mailing Address - Country:US
Mailing Address - Phone:262-501-7102
Mailing Address - Fax:
Practice Address - Street 1:2000 OBSERVATORY DR # 1037
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53706-1121
Practice Address - Country:US
Practice Address - Phone:608-262-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program