Provider Demographics
NPI:1124041694
Name:WITTENBRAKER, MARGARET T (ACNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:T
Last Name:WITTENBRAKER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 JAHNKE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4017
Mailing Address - Country:US
Mailing Address - Phone:804-320-2751
Mailing Address - Fax:804-673-9218
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-320-2751
Practice Address - Fax:804-673-9218
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00024000017363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001104914OtherRN LICENSE
VA00017136793OtherPRESCRIPTIVE AUTHORITY
VA0024000017OtherNURSE PRACTITIONER LICENS
VA1124041694Medicaid
VA1124041694Medicaid
MW0623618OtherDEA REGISTRATION
VA0001104914OtherRN LICENSE
VA1124041694Medicaid
VA018546C28Medicare PIN