Individual
VANESSA G WITTSTRUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2429 35TH AVE, GREELEY, CO 80634-4171
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
(303) 338-3382
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01650
KS
363AM0700X
Medical Physician Assistant
Primary
PA.0003759
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025837
KAISER COMMERCIAL NUMBER
CO
05
—
16985001
—
CO
Enumeration date
11/04/2013
Last updated
03/29/2021
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