MEDICARE: JILL M WITTE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	123577-030	WI
2	363LF0000X	Family Nurse Practitioner	3442-33	WI
3	363L00000X	Nurse Practitioner	3442-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3442-33	OTHER	WI	WISCONSIN LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	123577-30	OTHER	WI	WISCONSIN RN LICENSE

General Provider Information

NPI Number	:	1386817021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL M WITTE NP

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	800-326-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 E GREEN BAY ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166-2210
Country	:	US
Telephone Number	:	715-526-6244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	12/31/2025

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