Provider Demographics
NPI:1083915581
Name:WITSKEN, BRIDGET A (NP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:WITSKEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:A
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3299
Mailing Address - Country:US
Mailing Address - Phone:317-782-1577
Mailing Address - Fax:317-780-5538
Practice Address - Street 1:3834 S EMERSON AVE
Practice Address - Street 2:BUILDING C, SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203
Practice Address - Country:US
Practice Address - Phone:317-782-1577
Practice Address - Fax:888-366-7577
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164206A163W00000X
IN71003392A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201002490Medicaid
INM400039591Medicare PIN