Individual
HEATHER C WITTMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 653-9500
Mailing address
1 MEDICAL CENTER DR, DHMC- GIM, LEBANON, NH 03756-1000
(603) 653-9500
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0301
NH
363AM0700X
Medical Physician Assistant
055-0030388
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0301
LICENSE
NH
01
—
055-0030388
LICENSE
VT
05
—
2002091
—
VT
05
—
30011103
—
NH
Enumeration date
07/09/2006
Last updated
07/09/2007
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