TINA L VIDETIC (NPI# 1396930707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396930707 |
| Entity Type | Individual |
| Full Name | TINA L VIDETIC |
| Credential | APRN, BC |
| Practice Address |
2600 Kiley Way Plymouth WI 53073 |
| Mailing Address |
2600 Kiley Way Plymouth WI 53073-5020 |
| Practice Telephone | 9204574461 |
| Mailing Telephone | 9204574461 |
| Enumeration Date | 2007-09-09 |
| Last Update Date | 2020-03-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 3260 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
3260 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100013142 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 620 S Wisconsin Dr, Howards Grove, WI 530831263 | 9205654595 |
| Street Address |
2600 KILEY WAY |
| City | PLYMOUTH |
| State | WI |
| Zip Code | 53073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770558264 | Mauricio E Palencia | Emergency Medicine | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2006-02-20 |
| 1962016790 | Daniel Myron Lapean | Massage Therapist | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2020-08-31 |
| 1669003463 | Mitchell Adams | Pharmacist | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2020-01-30 |
| 1457911455 | April L Okruszynski | Physical Therapist | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2019-06-20 |
| 1235621228 | Andrea S Seifert | Physical Therapist | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2018-06-05 |
| 1740797851 | Dena Horvath | Nurse Practitioner | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2018-01-10 |
| 1922528710 | Bethany L Graesslin | Physical Therapist | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2017-06-22 |
| 1760911721 | Katie E Thompson | Internal Medicine | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2017-06-05 |
| 1003347451 | Anthony Lazaro | Family Medicine | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2017-03-27 |
| 1841642642 | Andrew Bradford Ingraham | Emergency Medicine | 2600 Kiley Way, Plymouth, WI 53073-5020 | 2016-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245889914 | Patricia M. Stone | Technician | 440 Stoneybrook Lane, Plymouth, WI 53073 | 2019-09-05 |
| 1801387501 | Kwon Yang | Dentist | W 9071 Forest Drive, Plymouth, WI 53073 | 2018-05-29 |
| 1396258752 | Advanced Dental Care Clinic Sc | Clinic/Center | 62 S Pleasant View Road, Plymouth, WI 53073 | 2017-11-08 |
| 1164888004 | Lukresse Tatiana Kouam Tchuendem | Registered Nurse | 236 N Milwaukee St, Plymoth, WI 53073 | 2016-01-07 |
| 1831447424 | Lori Ann Schuette | Registered Nurse | 406 Summit Street, Plymouth, WI 53073 | 2012-08-29 |
| 1821360967 | Kristine Marie Van Ess | Case Manager/Care Coordinator | 7135 Rocky Knoll Pkwy, Plymouth, WI 53073 | 2012-02-06 |
| 1750699708 | Shannon Diamond | Physical Therapist | 825 Walton Drive, Plymouth, WI 53073 | 2010-09-23 |
| 1306088265 | Lacey Lyn Schafer | Nurse Practitioner | W9071 Forest Dr, Plymouth, WI 53073 | 2009-03-24 |
| 1275780868 | Stella D. Kaas-lallensack | Occupational Therapist | W5774 Garton Rd, Plymouth, WI 53073 | 2008-08-26 |
| 1912172248 | Judith A Nelson | Registered Nurse | N7116 County Road E, Plymouth, WI 53073 | 2008-04-28 |
| Find all providers in zip 53073 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710417852 | Lois Joyce Roberson | Nurse Practitioner | 1032 Us Highway 64 E, Plymouth, NC 27962-9215 | 2017-06-12 |
| 1407221013 | Teresa June Taylor | Nurse Practitioner | 320 Court St., Plymouth, MA 02360 | 2015-12-08 |
| 1730558313 | Kendra Broussard | Nurse Practitioner | 101 Court St Ste 8, Plymouth, MA 02360-8718 | 2015-09-24 |
| 1285043828 | Georgia T Foudy | Nurse Practitioner | 258 Plympton Rd, Plymouth, MA 02360-4644 | 2014-08-07 |
| 1629329867 | Erin Duff | Nurse Practitioner | 1919 Lake Ave Ste 104, Plymouth, IN 46563-7830 | 2012-09-27 |
| 1760731798 | Daniel D. Tanner | Nurse Practitioner | 105 Water St, Plymouth, IN 46563-2148 | 2012-09-06 |
| 1144508904 | Kyle M Farr | Nurse Practitioner | 640 Starkweather St Ste C, Plymouth, MI 48170-1371 | 2011-07-28 |
| 1649372608 | Laura Ann Dansel | Nurse Practitioner | 595 Forest Ave, Suite 7a, Plymouth, MI 48170-1775 | 2006-09-01 |
| 1659336303 | Catherine T. Milne | Nurse Practitioner | 204 Keegan Rd, Plymouth, CT 06782-2608 | 2006-04-18 |
| 1881686996 | Janet Marie Lincoln | Nurse Practitioner | 8 Pilgrim Hill Rd, Minuteclinic/target Primary Practice 8 Pilgrim Hill Rd, Plymouth, MA 02360-6123 | 2005-08-16 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.