Provider Demographics
NPI:1245619295
Name:WITT, NORA (NP)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:NORA
Other - Middle Name:
Other - Last Name:DERVARTANIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:16205 SAND CANYON AVENUE, # 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-557-0000
Mailing Address - Fax:949-557-0001
Practice Address - Street 1:16205 SAND CANYON AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-557-0000
Practice Address - Fax:949-557-0001
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576354163W00000X
CA95002976363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner