Provider Demographics
NPI:1760474910
Name:DEWITT, JAMIE LEIGH (APNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:DEWITT
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-4523
Mailing Address - Country:US
Mailing Address - Phone:920-426-6100
Mailing Address - Fax:920-426-6109
Practice Address - Street 1:2601 FIELDCREST DR
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-4523
Practice Address - Country:US
Practice Address - Phone:920-426-6100
Practice Address - Fax:920-426-6109
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2124-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43976600Medicaid
WI43976600Medicaid
WI710180657Medicare PIN
WI453000619Medicare PIN
WI0014-45060Medicare ID - Type Unspecified