Provider Demographics
NPI:1417599028
Name:NITEK, LINDA JANE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:NITEK
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 1:1016 EAST DEVINE AVE
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:WI
Mailing Address - Zip Code:54819
Mailing Address - Country:US
Mailing Address - Phone:715-868-2332
Mailing Address - Fax:
Practice Address - Street 1:1016 EAST DEVINE AVE
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:WI
Practice Address - Zip Code:54819
Practice Address - Country:US
Practice Address - Phone:715-868-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider