Provider Demographics
NPI:1891768586
Name:BORTMANN, JOYCE LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:LYNN
Last Name:BORTMANN
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 1:3441 S 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4328
Mailing Address - Country:US
Mailing Address - Phone:414-541-7745
Mailing Address - Fax:
Practice Address - Street 1:3441 S 95TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4328
Practice Address - Country:US
Practice Address - Phone:414-541-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39910100Medicaid