Healthcare Provider Details

I. General information

NPI: 1881908861
Provider Name (Legal Business Name): DANIELLE BETTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITY CTR
OSHKOSH WI
54901-4830
US

IV. Provider business mailing address

500 CITY CTR
OSHKOSH WI
54901-4830
US

V. Phone/Fax

Practice location:
  • Phone: 920-456-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number169288-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: