Provider Demographics
NPI:1467110148
Name:UITENBROEK, TABITHA CHRISTINE (APNP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:CHRISTINE
Last Name:UITENBROEK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 N ORION LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7619
Mailing Address - Country:US
Mailing Address - Phone:920-427-9873
Mailing Address - Fax:
Practice Address - Street 1:4090 N ORION LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7619
Practice Address - Country:US
Practice Address - Phone:920-427-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11593-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily