Provider Demographics
NPI:1629038948
Name:WHITSITT, JUDITH ANN (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:WHITSITT
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 1:21601 COUNTY HIGHWAY F
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-6112
Mailing Address - Country:US
Mailing Address - Phone:715-568-3402
Mailing Address - Fax:
Practice Address - Street 1:21601 COUNTY HIGHWAY F
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-6112
Practice Address - Country:US
Practice Address - Phone:715-568-3402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75374-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38329100Medicaid