Provider Demographics
NPI:1417691684
Name:WITTENBERG, PAMELA SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:LAWARRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5565
Mailing Address - Fax:614-257-5289
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5565
Practice Address - Fax:614-257-5289
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH224849163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health