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General NPI Number Information
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NPI Number | 1346892957
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Entity Type | Organization
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Legal Business Name | ENERGIZE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/13/2019
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Last Update Date | 08/03/2019
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Provider Practice Location Address
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Address Line | 1700 SAND ACRES DR STE 2A
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City | DE PERE
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State | WI
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Zip | 54115-7562
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Country | US
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Telephone | 920-819-2657
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 LAWRENCE DR
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City | DE PERE
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State | WI
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Zip | 54115-9108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACEY HITTMAN
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Credential | FNP-BC
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Telephone | 920-373-8086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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