Individual
SHANNA WITGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN NP-C
Contact information
Practice address
509 HAMACHER ST STE 102, WATERLOO, IL 62298-1592
(618) 939-3939
Mailing address
509 HAMACHER ST, SUITE 102, WATERLOO, IL 62298-1592
(618) 939-3939
(618) 939-3941
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277000985
IL
363LF0000X
Family Nurse Practitioner
2013002942
MO
Other
Enumeration date
02/06/2013
Last updated
01/26/2023
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