Provider Demographics
NPI:1376656934
Name:WITTEKIND, CHARLOTTE L (NP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:L
Last Name:WITTEKIND
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:13405 BULACH RD
Mailing Address - Street 2:
Mailing Address - City:SUNMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47041-8822
Mailing Address - Country:US
Mailing Address - Phone:812-623-3313
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:3280 STATE ROAD 32 E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8731
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71000033A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232230HHMedicare UPIN