Provider Demographics
NPI:1720520919
Name:VERTZ, BARB
Entity Type:Individual
Prefix:
First Name:BARB
Middle Name:
Last Name:VERTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9685 SCHROEDER LN
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-8210
Mailing Address - Country:US
Mailing Address - Phone:715-927-1189
Mailing Address - Fax:
Practice Address - Street 1:W9685 SCHROEDER LN
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-8210
Practice Address - Country:US
Practice Address - Phone:715-927-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34080-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse