Individual
ANGELA RENA WITZMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS/APRN
Contact information
Practice address
1522 W MORRIS ST, INDIANAPOLIS, IN 46221-1629
(317) 957-2500
(317) 957-2520
Mailing address
3403 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 957-2000
(317) 957-2050
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
28110617A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
70000076A
IN
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
70000076A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000335051
ANTHEM PIN NUMBER
IN
05
—
200119010
—
IN
Enumeration date
06/15/2006
Last updated
11/27/2017
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