Provider Demographics
NPI:1497963755
Name:PITZ, LINDA SUSAN (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:PITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HAWTHORNE TER
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2928
Mailing Address - Country:US
Mailing Address - Phone:920-905-3558
Mailing Address - Fax:
Practice Address - Street 1:819 HAWTHORNE TER
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2928
Practice Address - Country:US
Practice Address - Phone:920-905-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85144-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38328200Medicaid