Provider Demographics
NPI:1497515720
Name:PITTENGER, ELYSSA (RN)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:
Last Name:PITTENGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13026 CLARET CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8641
Mailing Address - Country:US
Mailing Address - Phone:260-710-3080
Mailing Address - Fax:
Practice Address - Street 1:13026 CLARET CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8641
Practice Address - Country:US
Practice Address - Phone:126-071-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28240879A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse