Individual
MELISSA WITTEVEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1911 E REZANOF DR, KODIAK, AK 99615-6602
(907) 481-5000
Mailing address
1911 E REZANOF DR, KODIAK, AK 99615-6602
(907) 481-5000
(725) 793-7458
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60312120
WA
363AM0700X
Medical Physician Assistant
PA60312120
WA
Other
Enumeration date
09/11/2012
Last updated
01/03/2019
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