MEDICARE: DR. ANNA RAE KITOWICZ DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14469	WI

General Provider Information

NPI Number	:	1205604196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA RAE KITOWICZ DNP

Provider Business Mailing Address
First Line	:	160 COLUMBUS ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2247
Country	:	US
Telephone Number	:	608-577-9062
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 COLUMBUS ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2247
Country	:	US
Telephone Number	:	608-577-9062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	05/20/2024

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