Provider Demographics
NPI:1366004442
Name:KAPITZKE, DEANNA LYNN (APNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:KAPITZKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:WI
Mailing Address - Zip Code:54985-0016
Mailing Address - Country:US
Mailing Address - Phone:920-426-4310
Mailing Address - Fax:920-236-4197
Practice Address - Street 1:1505 NORTH DRIVE
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0016
Practice Address - Country:US
Practice Address - Phone:920-426-4310
Practice Address - Fax:920-236-4197
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9311-33163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult