Provider Demographics
NPI:1548714462
Name:WELLNITZ, KATRINA (CPHT)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WELLNITZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3392
Mailing Address - Country:US
Mailing Address - Phone:608-873-1342
Mailing Address - Fax:608-873-4009
Practice Address - Street 1:160 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3392
Practice Address - Country:US
Practice Address - Phone:608-873-1342
Practice Address - Fax:608-873-4009
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI580107010255420183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician