Provider Demographics
NPI:1518139682
Name:WITT, JOSHUA (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:WITT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 BROAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2211
Mailing Address - Country:US
Mailing Address - Phone:216-313-6322
Mailing Address - Fax:440-743-0552
Practice Address - Street 1:5755 BROAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2211
Practice Address - Country:US
Practice Address - Phone:216-313-6322
Practice Address - Fax:440-743-0552
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126511-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse