Healthcare Provider Details

I. General information

NPI: 1285538611
Provider Name (Legal Business Name): KENDALL NICOLE WITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1596
US

IV. Provider business mailing address

6225 RENEE CT
MCFARLAND WI
53558-9240
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-3000
  • Fax: 608-417-6027
Mailing address:
  • Phone: 608-417-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number252745-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: