Provider Demographics
NPI:1437921053
Name:WITTWER, TYLER JOANN
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOANN
Last Name:WITTWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:JOANN
Other - Last Name:WEIDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 TWINFLOWERS CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4830
Mailing Address - Country:US
Mailing Address - Phone:402-505-0423
Mailing Address - Fax:
Practice Address - Street 1:2210 TWINFLOWERS CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4830
Practice Address - Country:US
Practice Address - Phone:402-505-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician