Provider Demographics
NPI:1558640441
Name:ADAMETZ, ANNETTE PHYLLIS (LAC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:PHYLLIS
Last Name:ADAMETZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2022
Mailing Address - Country:US
Mailing Address - Phone:608-577-9642
Mailing Address - Fax:
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3542
Practice Address - Country:US
Practice Address - Phone:608-577-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI612-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist