Provider Demographics
NPI:1043766173
Name:WITTNER, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WITTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 WAGON WHEEL DR SE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6596
Mailing Address - Country:US
Mailing Address - Phone:218-556-6182
Mailing Address - Fax:
Practice Address - Street 1:2586 7TH AVE E
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3083
Practice Address - Country:US
Practice Address - Phone:218-210-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR127361-6163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health