Provider Demographics
NPI:1316602089
Name:WITTKOP, MELANIE (CNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WITTKOP
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8316
Mailing Address - Country:US
Mailing Address - Phone:419-297-2123
Mailing Address - Fax:
Practice Address - Street 1:343 HIDDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8316
Practice Address - Country:US
Practice Address - Phone:419-297-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty