Individual
MRS. MARY JANE WITTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
21 HIGHLAND AVE SE, SUITE 100, ROANOKE, VA 24013-2201
(540) 855-9177
(540) 345-7559
Mailing address
21 HIGHLAND AVE SE, SUITE 100, ROANOKE, VA 24013-2201
(540) 855-9177
(540) 345-7559
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0024074873
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649362351
GROUP NPI
VA
Enumeration date
12/27/2011
Last updated
12/27/2011
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