Provider Demographics
NPI:1710286141
Name:WITMAN, JODI L (NP)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:L
Last Name:WITMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 LAKEFRONT BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4345
Mailing Address - Country:US
Mailing Address - Phone:716-849-8750
Mailing Address - Fax:716-849-8757
Practice Address - Street 1:50 LAKEFRONT BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4345
Practice Address - Country:US
Practice Address - Phone:716-849-8750
Practice Address - Fax:716-849-8757
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336565-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner