Healthcare Provider Details

I. General information

NPI: 1205766557
Provider Name (Legal Business Name): KAITLYN BRESCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 DRAPER ST
BARABOO WI
53913-1231
US

IV. Provider business mailing address

1201 DRAPER ST
BARABOO WI
53913-1231
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-3944
  • Fax: 608-355-3944
Mailing address:
  • Phone: 608-355-3944
  • Fax: 608-355-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number224177-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: