Healthcare Provider Details

I. General information

NPI: 1083968010
Provider Name (Legal Business Name): VERONIQUE GETTIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 BYRD AVE 201
RACINE WI
53406-4878
US

IV. Provider business mailing address

5021 BYRD AVE 201
RACINE WI
53406-4878
US

V. Phone/Fax

Practice location:
  • Phone: 708-897-6489
  • Fax:
Mailing address:
  • Phone: 708-897-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number139888030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number139888030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: