Provider Demographics
NPI:1770237547
Name:LITVINOFF, JESSI (RN)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:
Last Name:LITVINOFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9792 HWY 70 STE 3
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-8747
Mailing Address - Country:US
Mailing Address - Phone:715-356-0034
Mailing Address - Fax:
Practice Address - Street 1:9792 HWY 70 STE 3
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-8747
Practice Address - Country:US
Practice Address - Phone:715-356-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI227961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse