1275776403 NPI number — GRETCHEN R WITOWICH MS, RD, LDN

Table of content: GRETCHEN R WITOWICH MS, RD, LDN (NPI 1275776403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275776403 NPI number — GRETCHEN R WITOWICH MS, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITOWICH
Provider First Name:
GRETCHEN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275776403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BELOIT HEALTH SYSTEM INC.
Provider Second Line Business Mailing Address:
1905 E. HUEBBE PARKWAY
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-364-2293
Provider Business Mailing Address Fax Number:
608-364-5452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BELOIT CLINIC
Provider Second Line Business Practice Location Address:
1905 E. HUEBBE PARKWAY
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-364-2400
Provider Business Practice Location Address Fax Number:
608-364-1534
Provider Enumeration Date:
04/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  164.004938 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 2978-29 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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