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Individual
KELLY ANN WITTENBROOK
Active
Individual
KELLY ANN WITTENBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172480
VA
363LA2200X
Adult Health Nurse Practitioner
306145
NY
363LA2200X
Adult Health Nurse Practitioner
APN.29631
SC
363LA2200X
Adult Health Nurse Practitioner
APRN.CNP.0037515
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01406284
—
NY
Enumeration date
07/20/2012
Last updated
02/13/2025
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