Tara Lyn Witczak, APN-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4766-33 Issued in WI

Practice address

1555 N Rivercenter Dr
Suite #206
Milwaukee, WI 53212-3981

Phone

(414) 272-5623

Fax

(414) 272-5617

NPI assigned

Mar 14, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331683200000",
    "number": "1710252408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 N RIVERCENTER DR",
            "address_2": "SUITE #206",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123981",
            "telephone_number": "414-272-5623",
            "fax_number": "414-272-5617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 N RIVERCENTER DR",
            "address_2": "SUITE #206",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123981",
            "telephone_number": "414-272-5623",
            "fax_number": "414-272-5617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITCZAK",
        "first_name": "TARA",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "APN-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-14",
        "last_updated": "2012-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "4766-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheyenne Leila Wiseman, M.D.
• Daniel Paul Wiske, DO
• Kenneth James Wisniewski, D.D.S.
• Carol Ann Witcher
• Jennifer M Witczak, P.T.
• With Love Home LLC
• With Purpose Mobile Phlebotomy Services
• Christopher J Withers, D.O.
• Vincent Withers, MSW, LMFT-IT
• Amber Witherspoon

• Adult Health Nurse Practitioner in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Adult Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.