Provider Demographics
NPI:1164549333
Name:WITTE, SARAH D (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:D
Last Name:WITTE
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:TERRY REILLY HEALTH SERVICES
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653
Mailing Address - Country:US
Mailing Address - Phone:208-466-7869
Mailing Address - Fax:
Practice Address - Street 1:223 16TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83653
Practice Address - Country:US
Practice Address - Phone:208-466-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily