Provider Demographics
NPI:1447238910
Name:WITTERT, DONNA D (APN CNP CDE)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:D
Last Name:WITTERT
Suffix:
Gender:F
Credentials:APN CNP CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7126
Mailing Address - Country:US
Mailing Address - Phone:847-795-9600
Mailing Address - Fax:847-795-9600
Practice Address - Street 1:3300 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7126
Practice Address - Country:US
Practice Address - Phone:847-795-9600
Practice Address - Fax:847-795-9600
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2090040111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201057Medicare UPIN
IL392830Medicare ID - Type Unspecified