Provider Demographics
NPI:1427041359
Name:BITTNER, WENDY SUE (PAC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:BITTNER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 PENN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6413
Mailing Address - Country:US
Mailing Address - Phone:641-682-8761
Mailing Address - Fax:641-682-2764
Practice Address - Street 1:1005 PENN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6413
Practice Address - Country:US
Practice Address - Phone:641-682-8761
Practice Address - Fax:641-682-2764
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant