Provider Demographics
NPI:1619382793
Name:WITT, ALICIA L (LICENSED MIDWIFE)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:WITT
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12790 W LUNDBERG ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-3728
Mailing Address - Country:US
Mailing Address - Phone:602-643-9433
Mailing Address - Fax:
Practice Address - Street 1:12790 W LUNDBERG ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-3728
Practice Address - Country:US
Practice Address - Phone:602-643-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM180176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife