Basic Information
| Provider Information | |||||||||
| NPI: | 1093836058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEITLER | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAUL | ||||||||
| OtherFirstName: | PATTI | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | N4785 PRAHL RD | ||||||||
| Address2: | |||||||||
| City: | LUXEMBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208455482 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | N6185 SCHOOL CREEK TRAIL | ||||||||
| Address2: | |||||||||
| City: | LUXEMBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208452128 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | WI | X | Nursing Service Providers | Registered Nurse | 163WH0200X | WI | X | Nursing Service Providers | Registered Nurse | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 38278300 | 05 | WI | MEDICAID |