Healthcare Provider Details

I. General information

NPI: 1992742126
Provider Name (Legal Business Name): ANNETTE M KORTH APNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

4938 COUNTY ROAD F
BLACK EARTH WI
53515-9714
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax: 608-280-7020
Mailing address:
  • Phone: 608-767-2042
  • Fax: 608-767-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2371-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: