Provider Demographics
NPI:1164113064
Name:WITTEN, JENNIFER ROSE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSE
Last Name:WITTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 S HERON LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6150
Mailing Address - Country:US
Mailing Address - Phone:480-313-3760
Mailing Address - Fax:
Practice Address - Street 1:244 N EXTENSION RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6300
Practice Address - Country:US
Practice Address - Phone:480-313-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ293252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner