Provider Demographics
NPI:1407831621
Name:WITTE, JUDITH ELIZABETH (RN MN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:WITTE
Suffix:
Gender:F
Credentials:RN MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NW 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838
Mailing Address - Country:US
Mailing Address - Phone:541-667-3732
Mailing Address - Fax:
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:SUITE E-37
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8602
Practice Address - Country:US
Practice Address - Phone:541-667-3492
Practice Address - Fax:541-667-3731
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00025363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213051Medicaid
ORS02932Medicare UPIN
OR213051Medicaid