Provider Demographics
NPI:1518353762
Name:WITTIG, DAWN (RN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WITTIG
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 1:2125 S MEMORIAL PL
Mailing Address - Street 2:STE 3
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3772
Mailing Address - Country:US
Mailing Address - Phone:920-459-0791
Mailing Address - Fax:920-459-0792
Practice Address - Street 1:2125 S MEMORIAL PL
Practice Address - Street 2:STE 3
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3772
Practice Address - Country:US
Practice Address - Phone:920-459-0791
Practice Address - Fax:920-459-0792
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219303-30163W00000X
171M00000X, 3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant