Provider Demographics
NPI:1508942541
Name:NOVITZKE, JANE ANTOINETTE (APNP, RN, NHA)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANTOINETTE
Last Name:NOVITZKE
Suffix:
Gender:F
Credentials:APNP, RN, NHA
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:ANTOINETTE
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NHA
Mailing Address - Street 1:1133 4TH AVE S
Mailing Address - Street 2:POST OFFICE BOX 110
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1922
Mailing Address - Country:US
Mailing Address - Phone:715-762-4600
Mailing Address - Fax:715-762-2835
Practice Address - Street 1:1133 4TH AVE S
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1922
Practice Address - Country:US
Practice Address - Phone:715-762-4600
Practice Address - Fax:715-762-2835
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI113 - 033363L00000X, 363LA2200X, 363LC1500X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43822500Medicaid