KELLY ANN WITTENBROOK ANP NPI 1073868519

NPI Information

NPI: 1073868519
Provider Name: KELLY ANN WITTENBROOK, ANP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

Address:
20 W FAIRMOUNT AVE
LAKEWOOD, NY
ZIP 14750
Phone: (716) 338-0033
Get Directions

Kelly Ann Wittenbrook, ANP is an adult health nurse practitioner in Lakewood, NY. Kelly Ann Wittenbrook, ANP NPI is 1073868519. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

20 W FAIRMOUNT AVE
LAKEWOOD, NY
ZIP 14750
Phone: (716) 338-0033
Fax: (716) 338-1575

The enumeration date for this NPI number is 7/20/2012 and was last updated on 5/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	306145	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01406284	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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