Provider Demographics
NPI:1578813606
Name:BROTZMAN, JOLINE (MS, RN, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:JOLINE
Middle Name:
Last Name:BROTZMAN
Suffix:
Gender:F
Credentials:MS, RN, PMHCNS-BC
Other - Prefix:
Other - First Name:JOLINE
Other - Middle Name:MICHELLE
Other - Last Name:LEVANETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PMHNP-BC, APNP
Mailing Address - Street 1:298 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4357
Mailing Address - Country:US
Mailing Address - Phone:920-315-3922
Mailing Address - Fax:920-214-1076
Practice Address - Street 1:459 E 1ST ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4505
Practice Address - Country:US
Practice Address - Phone:920-922-3324
Practice Address - Fax:920-929-3129
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5048-33363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100084008Medicaid
WI100026161Medicaid